
Clas 



sT?J"CI 



Book,,'.', 'I. 
GoH#tli? 



CTQESRIGHT DEPOSIT. 




"Brer Fox, he wink his eye slow, en lay low, 
en deTar Baby, she ain't sayin' nothinV 



The Care and Feeding 

of Southern Babies 



qA Quide for ^Mothers, G Nurses and 
^aby Welfare Workers of the South 



Owen H. Wilson, M.D. 

Professor of DISEASES OF CHILDREN 
VANDERBILT UNIVERSITY 



Baird-Ward Printing Company 

Printers and Publishers 

"Nashville, Tennessee 

1920 



^ 



^v 



Copyright, 1920 

by 

OWEN H. WILSON, M.D. 



Published and sold 

by 

BAIRD-WARD PRINTING CO. 

Nashville 



Price, $1.25 



MAY 22 1320 

©CLA571071 



PREFACE 

The excuse for adding another to the long list of 
Mothers' Guides is the necessity for special restrictions 
in diet and clothing for Southern babies, for whom simi- 
lar works written for cooler climates are inapplicable 
and unsafe. 

The purpose of the author has been to make this treatise 
as practical as possible, avoiding ultra-scientific and 
professional discussions. 

The growing interest in child-welfare signifies the more 
general appreciation of the fact that correct feeding and 
hygiene during childhood determine the mental and 
moral, as well as the physical characteristics of the man. 
We cannot expect enterprising future citizens unless our 
babies are healthy and thriving. 

The repetitions in the text are deemed necessary for 
completeness and emphasis. 

Owen H. Wilson. 

1620 West End Avenue, 
Nashville, Tenn. 



CONTENTS 



CHAPTER I 

PAGE 

The Care of Children 

Nursery 9 

Clothing 10 

Airing 14 

Baths 15 

Sleep 16 

Development 18 

CHAPTER II 
Feeding During the First Year 

Breast Feeding 26 

Mixed Feeding 37 

Weaning 39 

Wet Nursing 40 

Artificial Feeding 42 

CHAPTER III 

Feeding After the First Year 61 

Feeding in the Second Year 61 

Feeding in the Third Year 68 

The Care of the Mouth and Teeth 71 

CHAPTER IV 

The Traveling Baby 73 



Contents 
CHAPTER V 

PAGE 

Common Disorders Usually Caused by Improper Food.. 76 

Chronic Vomiting 76 

Constipation 77 

Diarrhoea 80 

CHAPTER VI 

Care of Sick Baby 84 

Nursing . 84 

Forced Feeding 87 

Baths, Packs, and Enemas 90 

CHAPTER VII 

Emergencies 93 

Sudden Vomiting 93 

Indiscretions in Diet 93 

Swallowing Foreign Bodies 94 

Abdominal Pain 94 

Croup 95 

Convulsions 97 

Nose-bleed 98 

Foreign Body in the Nose 99 

Foreign Body in the Ear 99 

Earache 99 

Burns and Scalds 99 

Bruises and Wounds 100 

Crying 100 



Care and Feeding of Southern Babies 
CHAPTER VIII 

PAGE 

Minor Ailments 

Birth-marks ^ 102 

Protruding Ears 102 

The Nervous Child 103 

Good Habits 105 

Bad Habits 106 

Bed-wetting 107 

Circumcision 110 

Bad Colds 110 

Adenoids and Tonsils 112 

Prickly Heat 115 

Chafing Buttocks 115 

Sore Mouth 116 

Intestinal Parasites 117 

Rectal Prolapse 119 

Sore Eyes 119 

Inactive Liver or Bilious Spells 120 

Nursing Cap 120 

CHAPTER IX 

Miscellaneous 122 

Starting Baby Correctly 122 

Don'ts 124 

Table of Development . 125 

Table of Heights and Weights 126 

Recipes 127 



CHAPTER I. 



THE CARE OF CHILDREN 



Nursery 

The ideal nursery should be the sunniest, airiest room 

in the house, preferably with a southeastern exposure, 

with windows on two sides. An open fireplace is 

Choice of fae best form of heating. A closed stove or an oil 

or a gas heater is not satisfactory. To prevent 

Heating accidents, the fireplace, radiator, or registers must 

be screened. Hardwood floors with washable rugs are 

desirable. The room must not be used for cooking or 

laundering purposes. 

Nearly all nurseries are kept too hot in winter. For 

young babies, 70° is the best day temperature and 60° 

Tempera- tne best n ig nt temperature. After the third month, 

ture of 68° in the day, and at night (except for very frail 

Nursery babies) it may be allowed to go as low as 50°. 

Hang a thermometer near the baby, on the same level, 

and watch the temperature. 

Avoid drafts, but have fresh air in the room at all 
times, even though it necessitates a fire to maintain the 
Ventila- correct temperature. Fresh air and sunlight are 
tion and as essential as to growing plants. Air the room 
Light thoroughly twice daily, once during the baby's out- 

ing and once before bedtime. Try to keep the source of 
light behind the baby, so it will not shine in his eyes. 



10 Care and Feeding of Southern Babies 

For the first weeks, the best bed is a bassinet or a 
clothes basket lined with muslin. Place in this a firm 

pillow or folded quilts, then a piece of rubber 
Bed cloth or stork sheeting, then a quilted washable 

pad. Later, a metal bed with a firm, not soft, mat- 
tress, protected by a rubber or stork sheet, then the wash- 
able pad. Pillows are unnecessary. The covering should 
be a sheet and light blankets. In very cold weather, an 
eiderdown or a wool comfort may be used. Do not have 
the cover too heavy. Chronic cold feet call, not for more 
cover, but for local heat, as a hot-water bottle, and 
demand also an investigation of the food. It is often a 
symptom of indigestion. 

Qothing 

The object of clothing is to make the baby comfortable 
and to keep in body heat. Garments should be as light 
as is compatible with this purpose, not binding — he 
will not fall apart — not tight enough to restrict exer- 
cise, yet not so loose that they lie in folds and make 
him uncomfortable. Babies suffer much more from 
overheating than from cold, and require less cloth- 
ing than adults, though a chilling is disastrous. In mod- 
ern, evenly heated homes they do not need the excessive 
clothing that old-fashioned babies required. Wraps of 
different weights and lengths should be provided for out- 
ings, according to the prevailing weather. 

At birth, a belly-band, simply a torn strip of very light 

flannel, four inches wide and long enough to go around 

his body once, is snugly pinned or tied with tapes, 

Clothes so as to retam tne cor ^ dressing. Do not make it 

too tight; if so, it is not only uncomfortable but 

is a frequent cause of vomiting. After nursing, see that 

it has not become uncomfortably tight. A few weeks 



Clothing 11 

after birth the baby begins to kick, and unless thq band 
is too tight for comfort, it will slip up over his chest and 
impede breathing. At six weeks, except in unusually 
frail babies, it should be replaced by a knit band or a 
sleeveless shirt of the lightest flannel, which is pinned to 
the napkin. This gives all the protection necessary. Um- 
bilical hernia, or rupture at the navel, is not due to the 
lack of bands, and not to faulty attention to the cord at 
birth, but to an abnormally large opening in the abdomi- 
nal wall around the navel cord. This defect is easily 
remedied at about the age of four months. 

The shirt, in winter, should be light wool, or better, 

a mixture of silk or cotton and wool. The double-breast- 

Sh'rts ec ^ smrt * s not a suitable summer garment, and not 

and best in furnace-heated homes even in winter. The 

Skirts skirt should be of light-weight wool and must hang 

from the shoulders — never pinned around the chest. It 

should be twenty-seven inches long. Over this the dress, 

twenty-eight inches in length, preceded probably by an 

underskirt, for exhibition purposes, is put on. 

The change to short clothes must be made at about 
four months. Some modern babies use them from birth 
Change to w * tn no detrimental effects. The demand for kick- 
Short i n g room calls for short skirts, and summer or 
Clothes winter they should be used. In cool weather, a 
long wrap or a blanket may be put on for a few days 
until the baby is accustomed to the short skirts. Heavy 
cotton stockings are preferable to wool, which shrink in 
laundering. They should be pinned to the napkin. Shoes 
may now be used. They should be soft, adaptable to the 
shape of the foot, never binding, and above all things 
never too small. As long as possible use soft moccasins 
to allow the foot to develop naturally. If the ankles 
are weak, or the arches flat, do not try to correct too 



12 Care and Feeding of Southern Babies 

early. The third year is soon enough, and by that time 
probably these defects will right themselves. 

Do not change weights of underwear by the calendar. 
If the baby is perspiring, he is too hot. Do not allow 

him to suffer because it is not May 15th. Dress 
Cfoth^no ky the hour and endeavor to keep him comfortable 

all the time. More babies take cold by overheating 
and overclothing in hot rooms than by chilling and 
fresh air. Frail children, with a tendency to colds, 
should be especially protected from overheating. On 
the first hot days, remove the flannel skirt and knit band, 
leaving only the shirt, pinned to the napkin, and the slip. 
In the early morning or late in the evening, put on 
outside wraps to suit the change in temperature. This 
is safer than trying daily to remove the knit band and 
skirt at 10 o'clock and to replace them at 5 in the after- 
noon. They might be overlooked, and make him suffer 
all through the noonday heat. Outside wraps are more 
noticeable, easier to adjust, and equally as satisfactory. 
Later on, the shirt may be removed and the knit band 
substituted, and in the hot summer time the dress and 
the napkin are the only articles necessary. In our South- 
ern climate, unless a child is very frail (I say this ad- 
visedly, in the face of time-honored superstition and high 
written authority) , the flannel garment is not a necessity. 
On cold or damp days, extra clothing can well be put 
on the outside. If, however, your faith in the supersti- 
tion that flannel must be worn over the stomach for the 
first two years is too strong, compromise by using only 
the lightest weight flannel knit band pinned to the napkin. 
This may be cut under the arms and over the shoulders 
and a muslin back adjusted, making two garments out 
of one. 

A very young baby may be given an oil rub and put to 



Clothing 13 

bed in the} same weight garments as those worn during 
the day. At four months of age, in the winter, he 
Garments snou ^ wear a shirt pinned to the napkin and a 
sleeping bag made of outing cloth (the only objec- 
tion to this material is that it is highly inflammable) , with 
long sleeves, and a drawing string at the bottom. Have it 
long enough to allow room to kick. In the summer, a 
knit band, or a knit band with the muslin back, and a 
thin gown, are enough, and in very hot weather, leave off 
the knit band. 

Two sizes of napkins are necessary — 18 by 36 inches 
for the first few weeks, then 22 by 44 inches later; or, if 
single ones are preferred, have them 18 by 18 
Napkins inches or 22 by 22 inches. They should be snugly 
adjusted, but never tight enough to bind or cause 
red lines about the leg. Do not have too many thick- 
nesses between the legs. A piece of thin cloth six inches 
square may be placed inside the napkin to catch the stool. 
This makes laundering much easier. Birds'-eye cotton is 
the best material for napkins. They should be used only 
once, and washed with a mild soap, and carefully rinsed 
in clear water. Many cases of chafing are due to soap or 
washing powder remaining after improper laundering. 
Soiled napkins must be kept outside the nursery, in a 
fly-proof receptacle. Never wash soiled napkins in the 
baby's bathtub. Rubber or stork cloth napkins are not 
permissible except for temporary use, as on a journey. 

The ordinary method of adjusting a napkin always 
awakens a feeling of sympathy for the helpless baby. It 
Adjusting must De uncomfortable, and if applied too snugly 
Napkins might even cause bone deformity. No great im- 
provement has yet been suggested, though the 
method in the accompanying diagram seems a little bet- 
ter. It is given, not as a substitute, but simply to show 
that there is more than one method, and with the hope 



14 



Care and Feeding of Southern Babies 



that some inventive mother may confer a blessing on 
unborn generations by improving even upon this. 




Figure i, 1 8-Inch Napkin folded once; 2, same folded again; 
3, Adjusted Napkin, points, E and F brought to A and B. 

Airing 

In the summer, take baby out as early as the second 
week; in the winter, at least after the first month. Then 
see that he has an airing every day of his life. Damp- 
ness, dust, and wind are his enemies. Wind can in a 
measure be avoided by a gauze veil, by a hooded car- 
riage, and by avoiding the windy side of the house. 
He does not have to be in motion — simply roll the 
carriage to the proper place and let it stand. If the 
weather is cold, put a hot water bottle under the blanket. 
On damp or very cold or dusty days, dress him as for 
the outing and give an indoor airing by opening all the 
windows and closing the doors. Be careful of the atmos- 
phere of melting snow. When the thermometer is below 
24°, indoor airings are sufficient. Auto rides, if not too 
breezy, are permissible for young babies, but have no 
advantage over standing still in the buggy. A go-cart is 
a poor substitute for a roomy, comfortable carriage. It 



Baths 15 

is too cramped, a poor support for the back, and is too 
low on the ground. The only advantage is its conve- 
nience. It offers many chances for outings otherwise 
missed. 

The First Bath 

The! first bath should be given as soon after birth as 
possible. After the doctor has used a few drops of silver 
solution in the eyes, and the baby has been anointed 
with some oil, preferably warm olive oil, to remove 
the gummy substance which covers him, then quickly 
bathe him in warm water, temperature 100°, using a 
mild soap. Watch the temperature carefully; babies 
have been scalded. Gauze or cotton makes the best 
wash cloth. He should be dried by patting, not rub- 
bing, and rapidly dressed, to conserve the body heat; 
in fact, if very frail, he is simply anointed with oil and 
wrapped in soft woolen blankets and the bath postponed 
until he is stronger. Then put a hot water bottle under 
the blanket, but be very careful not to let it touch him. 
Even though the bottle seems only fairly warm, the skin 
is tender and quickly blisters. 

At first, the mouth may be gently sponged out with 
gauze or cotton on a match or a wooden applicator. 
After this preliminary; cleansing, it is best not to wash 
the mouth until after the teeth appear. The mucous 
membrane is too tender, and more harm than good is 
done. In my experience two babies have been fatally 
injured by washing the mouth, and this by trained nurses. 

Subsequent Baths 

Until the cord is separated and healed, the sponge bath 
must be continued, then a quick tub bath, at first with a 
temperature of 100°, lowered to 95° by the time he is 
three months old. Much backbreaking strain can be 



16 Care and Feeding of Southern Babies 

avoided by using an elevated tub. A bath thermome- 
ter is almost a necessity. Always test the temperature 
of the water immediately before putting him into it. 
If you have no thermometer, use your elbow, not your 
hand. Bathe his face and head first, then sponge the 
eyelids and genitals with boric acid solution. Do not 
try to put anything in his eyes — simply sponge off the 
lids. Wash out the nostrils and ears as well as you can 
with a cloth on your finger. Do not go up inside of 
these cavities, as is frequently done, by using a toothpick 
and cotton. Only harm can be expected from this. Place 
him in the tub with your hand under his back for sup- 
port, then bathe the rest of his body. When old enough 
to sit up, he may be allowed to play a few minutes in 
the water, but guard against chilling, which is indicated 
by the extremities being cold or blue after the bath. 
Use very little soap. 

Make the baby like his bath. If necessary, bathe the 
face last, using fresh water, of course. Try the effect of 
floating toys in the tub. 

Dry rapidly with a soft, old towel, more by patting 
than rubbing, and dress him lying in the lap, pulling 
the clothes over his feet. 

Sleep 

A young baby should sleep eighteen to twenty hours 
out of twenty- four; at one year, fourteen; at two years, 
twelve to fourteen; and throughout childhood, twelve 
hours. At first he should have two naps daily; after 
the first year, one is probably sufficient. Arrange naps 
so that they do not interfere with the airing. In win- 
ter, in our Southern climate, there should be one nap 
early in the morning and one late in the afternoon, 
leaving the midday for fresh air, while in the summer, 



Sleep 17 

he must have the early morning and late afternoon 
for outings, the naps coming from 9 a.m. to 12 M. and 
3 to 5 P.M. There is no harm, rather benefit, in 
outdoor naps. Sleeping porches are good for babies 
except in severe! weather. Teach them to sleep without 
rocking, without foolers, both with and without light in 
the room, both with and without noise; only be sure that 
they are comfortable and well fed. They are creatures 
of habit even more than adults, and may be trained in 
almost any way. 

Posture in sleep is varied, sometimes perplexing. 
Some babies normally sleep with their eyes half closed, 
some with the head thrown back, others on the elbow and 
knees, a most uncomfortable position. It is well to 
change the position, especially with young babies. Con- 
tinually lying on one side might flatten the head. Under 
no circumstances should a child sleep with mother or 
nurse. 

Restless sleeping may be due to one or more of the 
following causes: 

1. Improperly ventilated or overheated room. 
Restless 9 u,„JL 

•"- 1 5r 

4. Soiled napkin. 

5. Indigestion. 

6. Constipation, especially if there is a lump in the 
rectum. 

7. Too much cover. 

8. Uncomfortable clothing. 

9. Heavy supper. 

10. Adenoids or cold. 

11. Irregular, excited bed hour. 

12. Acute illness. 

Heavy covering or restless sleep, due to intestinal dis- 



18 



Care and Feeding of Southern Babies 



Kicking 

Off 

Covers 



Birth 
Weight 



comfort from indigestion, starts the habit of kicking off 
the covers. See if he is too warm. Babies need 
comparatively light covering. Correct any diges- 
tive disorder. Horse-blanket pins forcibly hold 
covers in place, but a better and a more comfortable plan 
is to fasten covers to the bed with a strip of elastic 
webbing or a pair of men's garters. This allows kick- 
ing, but the covers fall back in position. 

Development 

The average weight at birth is seven or seven and a 
half pounds. As 1 a rule, the child's vitality varies with 
his birth weight. Unusually large babies are 
likely to be handicapped by severer obstetrical 
injuries. If under four pounds, the vitality is 
feeble, and special attention should be paid to keeping 
them warm and nourishing them, for usually they are 
too weak to be depended upon to draw the milk from the 
breast. 




EXCELLENT BABY SCALES, 

Weighing 31 Pounds by 1-4 Ounces. Manufactured by Jacobs 

Bros. Co., 223 Wallabout St., Brooklyn, New York 



Development 19 

The weekly gain should be one-fourth to one-half 

pound ; usually more the first six months than the second 

Progress- s i x months. The weight should be watched care- 

ive fully, accurately weighing once (preferably twice) 

Weights weekly during the first year. Get the net weight, 

always at the same time of day with reference to feeding. 

Failure to gain the four ounces (do not wait for a loss) 

is a danger signal which demands investigation. Daily 

weighings are apt to be perplexing. 

At six months (usually at five), a normal baby should 
double his birth weight, weighing fourteen pounds; at 
one year, treble it, weighing twenty-one pounds. In the 
second year, the growth is less regular and not so marked, 
the gain for the entire year being only seven pounds. 
After the second year, the average gain is about three and 
a half pounds yearly. 

Small or extra large babies do not follow the birth- 
weight rule. The five-pound baby, if flourishing, should 
weigh twenty-one pounds at one year old; and likewise, 
the ten-pound baby could not be expected to weigh thirty 
pounds at one year, though at six months he is a little 
above, and the smaller one is a little below, the standard 
of fourteen pounds. 

After four years, sometimes earlier, personal heredi- 
tary traits or tendencies show — that is, stoutness or tall- 
ness. Up to this time, we must not be satisfied unless 
the child conforms to the standard of weight, no matter 
how thin his parents may be. 

Length is not such an important standard, and is 

earlier influenced by family tendencies. The average 

length at birth is twenty and a half inches; at one 

Length year, twenty-nine inches; after this the growth is 

three to four inches a year. Thus at five years 



20 Care and Feeding of Southern Babies 

his length should be forty-one inches and his weight 
forty-one pounds. 

At birth a baby should grasp and almost lift his chest 

from the bed by holding to a pencil or your finger. He 

Muscular should hold his head erect at four months, play 

Develop- with a toy at five months, and sit alone at least at 

ment eight months, usually at six, if propped against a 

pillow. He should stand at one year; he should crawl, 

if he ever does, at about the same time, or even a little 

earlier. 

Age at which walking is begun is indefinite, but if he 
does not walk before eighteen months, the doctor should 

be consulted. Some babies walk as early as nine 
Walking months. It depends upon two factors: muscular 

strength and an inherent sense of equilibrium, 
which varies even in adults. One man can walk a girder 
on top of a high building, while the thought of it makes 
another shudder. Some normal children, lacking in this 
sense of equilibrium, refuse to walk alone. In these 
cases, and in these only, a baby-walker may be used. 
Pigeon-toe, or toeing-in walking, is natural for beginners. 

The leg is normally curved slightly. This curvature 

is soon outgrown. The permanent deformity of bowlegs 

is due to the softened bones of rickets, a disease 

Bowlegs produced by improper food and bad hygiene, and 

not to premature standing on the feet. Let a baby 

do anything he really wants to do, but do not force him, 

even if backward. 

At birth the largest circumference of the head around 

the forehead and occiput is thirteen and a half inches. 

At one year it should be eighteen inches; at two 

h' 2 ® * . years, nineteen and a half inches; at three years, 

twenty inches, while the adult measures about 



Teeth 21 

twenty-two inches. The anterior fontanelle, or soft spot, 
on top of the head, closes at eighteen months, frequently 
at fourteen. 

jo CP upper Q '° 
J^Tempoiartj Teeth ^^ 

9 &r^\ Lower 




7 4 I 14- ' 

DIAGRAM ILLUSTRATING THE TEMPORARY TEETH, 

i, i, 2, 2 Central Incisors; 3, 3, 4, 4 Lateral Incisors; 5, 5, 6, 6 First 

Molars; 7, 7, 8, 8 Canines, or Eye and Stomach Teeth; 

9, 9, 10, 10 Second Molars. 

Teeth are the most important standard of development, 

indicating the progress of a child, and more or less the 

state of nourishment, though some perfectly nor- 

Teeth ma l children are backward in this respect. Upon 

investigation this usually proves an hereditary trait. 

There are twenty temporary teeth, divided into five 
sets of four each: four central incisors, four lateral in- 
cisors, four first molars, four canines (the eye and stom- 
ach teeth), and four second molars. As a rule (excep- 
tions are numerous), teething begins at six months, and 
every three months a set of four is erupted, provided 
nutrition is progressing satisfactorily. The central in- 
cisors come from six to nine months; the lateral incisors 
from nine to twelve months; then the first molars from 
twelve to fifteen months; the canines from fifteen to 



22 Care and Feeding of Southern Babies 

eighteen; the second molars rather irregularly, but after 
eighteen months, sometimes even as late as the third year. 
Usually, the lower two of a set precede the upper. An 
exception to this is that the upper lateral incisors quickly 
follow the upper central incisors. The lower lateral in- 
cisors are quite irregular, sometimes being delayed until 
after the canines. 

To the eruption of the teeth were once attributed all 
the ills of baby days, from diarrhoea to convulsions. 
Disorders Mere teething is never responsible for serious ill- 
Caused by ness. During the immediate process the gum is 
Teething rec l an( J swollen, there is often restlessness and 
slight temperature — not over 100° — loss of appetite, and 
certainly a weakened digestive power, so that food which 
has previously been digested easily, disagrees. Teething 
cannot cause severe illness, but by weakening the diges- 
tion, slight disorders may quickly become serious. 

The eyes of all new-born babies are a dull blue, and 

begin to take permanent color only after three or four 

months. During the first weeks, the eyes may not 

Eyes be under muscular control, hence cross-eye is not 

uncommonly observed. It is not permanent and 

needs no treatment. 

The first hair wears off about the age of four 
Hair months and is slowly replaced, probably by an 

entirely different colored growth. 

At one year a baby should be able to say single words, 

such as "mamma" and "papa." Girls talk earlier than 

boys. Nouns are learned first, then verbs, then 

Speech adjectives, then adverbs, and finally pronouns, 

which seem to puzzle their minds immensely. 

Late speech is due to one of three causes: deafness, 



Speech 23 

idiocy, or indifference, the last the result of spoiling. 
The process of learning and using a word is quite 
Delayed interesting. For instance, take the word "water." 
Through his senses the child must learn the char- 
acteristics and uses of water, then he must watch his 
mother's lips, then imitate the sound she makes. As every 
word in his vocabulary is acquired by this same process, 
it is not astonishing that if he can make a sigh and get 
what he wants, he will much prefer to do it. By obeying 
his signs and making speech unnecessary, some normal 
babies do not talk until they are four years old, frequent- 
ly learning with a younger child who will not interpret 
these signs. 

Tongue-tie is a rare deformity, the tongue being bound 
down to the floor of the mouth so closely that it cannot 
be raised even to the roof of the mouth in the 
ongue- process of sucking. It never causes delayed speech, 
as sound is made in the larynx and not by the 
tongue, but may possibly be the cause of incorrect enun- 
ciation of certain lingual sounds. 

Baby talk is the result of imperfect imitation of cor- 
rect speech. It is cute and interesting at first, but should 
never be used by adults to children. They are 
Talk doing their best to imitate you. Do not set a child 

an imperfect copy, otherwise the imperfection 
may persist until after he is old enough to be embarrassed 
by it. If he has special difficulty in the enunciation of 
certain sounds, train him early to overcome it. 

Stammering appearing before the eruption of 
j n _ the permanent teeth is usually temporary. At any 

age it is a symptom of an overwrought nervous 
system, and should be so treated. (See page 103.) 

The first bowel actions are tarry black and usually 



24 Care and Feeding of Southern Babies 

come within twenty-four hours after birth. Even if de- 
layed, no purgative is necessary if baby is normal. 
Stools The first secretion of the breast before milk ap- 

pears is supposed to act as a laxative. When milk 
is taken, yellow spots should begin to show in the black 
stools, and by the fifth day they should be entirely the 
normal color, orange yellow. Throughout the first year 
there should be one to four stools daily. One is suffi- 
cient; four not too many. The consistency and color is 
about that of the yolk of an egg. If cows' milk is used, 
the color tends more to lemon yellow than to orange and 
the stools are more consistent. If cereal water or malt 
sugar is used in preparing the food, they are oak brown. 
Castoria causes a dark brown stool. 

The bladder contains urine at birth which should be 

expelled within the first twenty-four hours. It is not un 

usual for urine not to pass even until after the sec 

Urine ond day. This delay is of no significance. Con 

tinuous crying the first three or four days of life. 

is often due to a deposit in the bladder or kidneys of crys 

tals of uric acid, which shows as a stain on the napkin 

and after it all passes the pain is relieved. The treat 

ment, of course, is giving water to wash it out. 

For the first four days the bladder is emptied every 
four to six hours; afterwards throughout infancy at about 
two-hour intervals. The urine should be perfectly clear 
and as colorless as water. Condensed milk or other foods 
with an excess of sugar seem to cause an excess of urine. 
Large quantities of fat in the food may produce an am- 
moniacal odor. 

Scant urine is suggestive of either too little fluid — that 
is, milk — or excessive perspiration. On the first hot days, 



Urine 25 

Suppres- while winter clothing is still worn, little or no 
sion of urine may be passed for twenty-four or forty-eight 
Urine hours, as so much water is lost through the skin. 

This suppression seems to do little harm except to make 
the baby fretful. The treatment is giving water and keep- 
ing cool. 

When the kidney function is abnormal, the urine should 
be examined, but it is sometimes difficult to obtain it. 

Methods '^ n eas ^ wa ^ * s to catcn tne urme on a sponge or 
of Collect- cotton, and squeeze it out. This is satisfactory for 
I ng Urine a chemical examination, but not for microscopical 
for Exam- wor k ? which is more important. For boy babies, 
fasten a bottle or test tube to the penis with a little 
adhesive plaster. The best method is to give plenty of 
water, then wake just before finishing a long nap, and ap- 
ply a warm wet cloth over the bladder and place a clean 
cup in position to catch the specimen, which will come in 
a few minutes. Do not wait for him to awaken, as it is 
usually just at the moment of emptying the bladder. 
Use no talcum powder while trying to get the specimen. 
If this method is not successful, scrub a piece of rubber 
sheeting, wash baby free from lint and powder, and have 
him lie on it with hips in a depression until the urine is 
passed, then collect it with a spoon. 



CHAPTER II. 



FEEDING DURING THE FIRST YEAR 

Breast Feeding 

The baby is but an exponent of the food and care he 
gets, and human milk is preeminently built for a baby, 
and he for it. 

In former times, breast-feeding was almost universal; 
a bottle-fed baby was a curiosity. He was nursed 
when he cried and could always rely upon a 
Feed?" bountiful supply, regardless of irregular habits. 

Fifteen years ago it was rare to see an entirely 
breast-fed baby. This was due to the strenuousness of 
living conditions, and not (as has been frequently attrib- 
uted) to the unwillingness of mothers to nurse their off- 
spring. They tried to keep up nursing on the old hap- 
hazard plan anct at the same time fulfill modern social 
and domestic demands. Owing to better regulation, ma- 
ternal nursing now seems to be more and more successful. 

It is not necessary that a good mother become a recluse, 
far from it; but she must recognize that to supply the 
Hygiene baby is her chief aim in life; that for the first few 
of the months it is a big undertaking, and that other 

Nursing things must be subservient. The strain is certainly 
er much lessened by proper training and regularity. 
A trained baby is a great pleasure; an untrained baby a 
ceaseless care. Training should begin at birth. A new 
mother should live as normal and regular a life as pos- 
sible. Above all things, she should get plenty of sleep. 



Breast Feeding 27 

She is obliged to lose some with the baby, so let her 
keep up the habit of a midday nap, or rest, and an early 
retiring hour during the entire nursing period. 

She should have as much exercise or fresh air as is 
consistent with her condition and strength. This, of 
course, depends upon the age of the baby and the 
Exercise difficulties of her confinement. As a rule, she can 
exercise to any extent that does not cause back- 
ache and ai dropping feeling in the pelvis, or that does 
not produce an increase or a return of the flow, which 
should cease at six weeks. 

She should have a liberal diet, avoiding any risk of 
digestive disorder. As a rule, any food which agrees 
with her will produce good milk. Vegetables and 
Diet fruits should be taken freely from the beginning. 

It is extremely rare that foods, even acid fruits, 
taken by the mother cause colic in the baby. She should 
drink plenty of fluids, but not to such an excess that it 
will diminish the appetite for more substantial things. 
By all means should she avoid nervous and physical over- 
exertion, which in most cases is the cause of indigestible 
or poor milk. The milk secretion seems to have a closer 
connection with the nervous system than with the diges- 
tive. 

Few indeed are the contra-indications to nursing. Tu- 
berculosis, Bright's disease, or other wasting conditions 
. might demand weaning, but remember it means 
dications lessening the baby's chances to live and grow nor- 
to Breast mally, and increases susceptibility to disease. 
Feeding 

Acute illness, unless severe, does not require 
weaning. The baby should be put to the breast regu- 
larly if the mother is not too ill, but as the supply is 



28 Care and Feeding of Southern Babies 

apt to be diminished, artificial food should be used to 
fill out the nursing. 

Colds are contagious, and if the mother is so affected 
she should hold a handkerchief over her mouth and nose 
while nursing, and keep the baby in a different room as 
much as possible. 

The return of the menstrual flow does not mean that a 
baby should be weaned. As a rule, the milk supply is 
Effect of disturbed during the time of flow, but not perma- 
the Men- nently so. It is advisable to begin with one arti- 
strual ficial feeding daily when the period is regularly 

F,ow established. This does not apply to the slight ap- 

pearance of the flow, which is not infrequently seen about 
two months after birth. This is really a hemorrhage 
from over-exercise, and not the establishment of the regu- 
lar habit to be repeated monthly. 

Even pregnancy is not a signal for sudden weaning. 
The milk of a pregnant woman is not poisonous, as has 
been supposed. However, no woman can successfully 
nourish herself, the baby in the womb, and the one at 
the breast; one or the other will suffer, and usually it is 
the babe at the breast, through deterioration of the quan- 
tity and quality of milk — not poisoning, only starvation. 
Mixed feeding should be begun when pregnancy is sus- 
pected and increased to gradual weaning. 

Nursing Habits 

As soon as the mother is rested after the birth, put the 

baby to the breast for five minutes at each side, every six 

Before hours until the milk appears, which is usually on 

the Milk the third day. This accustoms the baby to taking 

Comes the nipple, gives him the fluid (colostrum) secreted 

before the milk, which is supposed to act as a purgative, 



Nursing Habits 29 

and also helps the contraction of the enlarged womb. 
Before and after nursing, sponge the nipple with boric 
acid solution (a level teaspoon to one-half pint of water) . 
Do not let him nurse too long — ten minutes is sufficient — 
otherwise he will water-log the nipples and make them 
tender. 

Between nursings give one-half to one ounce of warm 
boiled water, unsweetened. For the first weeks this water 
should be given in a spoon, otherwise it might make him 
neglect the breast; but after this, try to teach him to take 
it from a bottle and nipple. 

As soon as the milk flow is established, begin his regu- 
lar schedule, nursing alternate breasts ten to twenty min- 
utes, at 6, 9 A.M., 12 m., 3, 6, 9 p.m., and 2 A.M., 
Nursing giving warm water between times. This may be 
made one hour later at each interval if the mother 
prefers it, beginning at 7 A.M. Wake him up for the 
day nursings. After nursing, baby should lie quietly in 
bed for at least half an hour. Allow but one nursing 
from 9 or 10 P.M. to 6 a.m. Really there is no neces- 
sity for even that, so do not awaken him for it. The 
intervals must be counted three hours from the beginning 
of one nursing to the beginning of the next. I am cer- 
tain that the average baby thrives better on the three- 
hour interval than nursing every two hours, but I am not 
sure that four hours would not suit some better. What- 
ever interval you select, be exact about it. Wake him a 
few times and it is surprising how quickly he learns to 
wake with clocklike regularity. 

As a rule, alternate breasts are used, the right at 6 a.m., 
12 M., 6 p.m. and 2 a.m.; the left at 9 a.m., 3 and 9 
P.M. The next day begin with the left. If he is allowed 
to have both breasts at one nursing, he may neglect to 



30 Care and Feeding of Southern Babies 

empty them thoroughly, taking only the first portion, 
which draws easily, leaving the richer part, the strippings, 
in the breast. Nothing is so deleterious to the milk sup- 
ply as partial emptying of the breast. A lazy milk boy 
will dry up a cow. If there is too much milk for one 
baby, at least once a day completely empty the breasts 
with a pump; or, better still, help out some suffering 
artificially fed little one, but be sure that he is healthy. 

The time limit for each nursing is from ten to twenty 
minutes. Too rapid nursing, less than ten minutes, may 
Time of cause vomiting or indigestion, just as bolting the 
Each food does. Too rapid flow of the milk may be pre- 

Nursing vented by a slight pressure on the milk ducts with 
the fingers near the nipple. If this is not effective, try 
nursing uphill — that is, the mother sitting upright in her 
chair, holding the baby's head high, making him draw 
the milk up instead of having him below the breast with 
the flow assisted by gravity. If this fails, nurse him one 
or two minutes then let him rest, or cry, for two minutes, 
and so prolong the feeding. Too slow nursing means 
that the baby is lazy. Take him away at the end of twen- 
ty minutes, even if he is not satisfied, and the next time 
he will work harder. It may also mean an insufficient 
supply of milk. If the milk is not there, prolonged nurs- 
ing will not make it, but will worry the mother and tend 
to injure the nipple. Take him away after twenty min- 
utes, and resort to some other method for filling him up. 
(See "Mixed Feeding," page 37.) 

The 2 A.M. nursing is the only one that baby should 

not be wakened for, and he usually soon forgets it and 

sleeps from 9 or 10 p.m. to 6 a.m. There is no 

Midnig t necessity for this nursing, and as soon as he is 

willing let him omit it. It must be stopped at four 

months, if not before. This can be done by letting him 



Unsatisfactory Nursing 31 

cry it out a night or two ; or, better, by giving him water, 
or by substituting an artificial food at this interval, and 
reducing the quantity given one ounce each night. Noth- 
ing helps the mother's supply so much as a full night's 
sleep, and once baby gets in the habit of sleeping from 
9 P.M. to 6 A.M., under no circumstances begin night 
feeding again. Early waking hours are sometimes trou- 
blesome. Do not begin early feedings. Try giving warm 
water, and make his afternoon nap shorter, or his bed- 
time a little later. Do not disarrange his intervals. 

Unsatisfactory Nursing 

A satisfactorily nursed baby must gain one-fourth to 
one-half a pound a week, nurse ten to twenty minutes, and 
sleep, or appear satisfied afterwards, and must sleep 
soundly day and night. 

Unsatisfactory nursing is shown by failure to gain, by 
prolonged nursing (over twenty minutes), crying too 
much, and poor sleeping. These symptoms may be ex- 
plained by disordered quality or quantity of milk. 

Over-rich milk is the most common defect. Poor milk 
is very rare except in factory districts, where mothers are 
Disordered overworked or underfed, or both. When a mother 
Quality gets up from her confinement, or returns from the 
of Milk hospital, and the nurse leaves, she is confronted 
with new responsibilities, and almost invariably be- 
comes nervous, and the baby is upset. Few babies es- 
cape. Sometimes it shows as a diarrhoea, possibly ten or 
twelve chafing stools daily. This is not serious in breast- 
fed babies, and disappears when normal habits for the 
mother are reestablished. 

Colic is a more distressing symptom. It is indigestion 
due to over-rich food, caused by the mother's nervous 



32 Care and Feeding of Southern Babies 

condition, and usually increased by bad nursing 
Colic habits. Certainly it cannot often be explained by 

the mother's dietetic errors. Her food, of course, 
should be restricted as before suggested ; and her rest 
hours must be safeguarded. 

Colic begins usually at three or four weeks, coincident 
with the mother's first attempt to care for the baby and 

possibly to attend to her household duties as well. 
of "cShc 18 ^ ne cn ^d k thriving, making his weekly gain, may 

at other times appear to be perfectly healthy, 
stools normal, or possibly showing a little white curd on 
a greenish or yellowish background. Occasionally it may 
be associated with chafing diarrhoea. He nurses well and 
contentedly, sleeps a few minutes, then wakes up scream- 
ing and may continue until exhaustion stops him. He 
draws up his feet, which are cold; the abdomen is tight; 
he is evidently in pain. It is a great temptation to nurse 
him again. This is probably the only way to quiet him 
temporarily; he cannot cry and nurse too, and the warm 
milk is soothing, but it is only adding fuel to the fire. 

His crying must be stopped, else the mother will be 
more nervous and her milk even worse tomorrow — a 
vicious cycle: baby's crying makes the milk bad, and that 
causes more colic next day. Sooner or later the milk, 
plentiful but too rich in quality, becomes deficient in 
quantity, owing to the mother's increasing nervous strain, 
and weaning, with its woes, may be necessary. Colic is 
rare in well regulated babies; start them right and keep 
them right. 

Regulate nursings. If he is on a three-hour schedule, 

go to four hours. Do not allow him to oversleep his 

The Treat- interval, even though it is a great temptation to let 

ment of him sleep on, for he will then nurse too fast and 

Colic take too much, causing a worse spell next time. 



Colic 33 

The mother should take as much fresh air and exercise as 
are consistent with her strength; her diet should be nor- 
mal, avoiding an excess of meat or very acid fruits. She 
must rest, even if she has to go to another house to do so. 
Temporarily relieve her of all responsibilities and give 
the baby plenty of warm water between nursings. When 
possible, give before nursing one teaspoon of lime water 
in* two tablespoons of warm water. The so-called three- 
months colic means that the indigestion lasts until the 
mother has become accustomed to the care of the infant 
and has resumed her normal life, which is usually at the 
end of three or four months, hence the popular term, 
"three-months colic." 

By regulating mother and babe, colic can be cured, 
but this requires several days at least to take effect. For 
temporary relief, you must resort to some more 
emporary ra pjj me ans. The pain must be speedily stopped. 
He is suffering intensely, the mother sympathizing. 
The following list of perfectly harmless remedies is sug- 
gested : 

First — Wrap him in a warm blanket. 

Second — Put a teaspoon of cooking soda (sodium 
bicarbonate) in a glass of hot water, and give him a table- 
spoon of this mixture. If the cause of the trouble is 
an acid stomach, the relief is immediate. 

Third — If no results in two minutes, give ten drops of 
milk of asafoetida in a tablespoon of hot water. If 
relief is to be expected from this, it will be immediate, 
following belching. 

Fourth — If not quiet in two minutes more, see if the 
trouble is not in the lower bowel. Give a warm-water 
enema, using an ear and ulcer syringe, not the ordinary 
hard-tipped infant syringe. 

—3— 



34 Care and Feeding of Southern Babies 

Fifth — If not quiet in two minutes, give ten drops of 
milk of asafcetida in a syringe full of water, by enema. 

All these remedies are perfectly harmless and all may 
be given within ten minutes. 

If he is still suffering, the site of the indigestion must 
be in the small intestine, and not amenable to immediate 
treatment. But the child is in pain, and for his sake, as 
well as the mother's — and, incidentally, for the rest of the 
family — he must be relieved; otherwise, the milk of the 
nervous mother will cause another spell tomorrow. Much 
as I dislike to give it, paregoric is now indicated in re- 
peated doses until the child is quiet, the amount to be 
regulated by a physician. 

Logically it would appear that as there is something 
undigested in his intestines, it should be removed by a 
Purgatives purgative, but this will do no good, rather harm. 
Must Not It would be some hours before we could expect 
Be Used relief from the purgative and then it only cleans 
out the undigested breast milk; and unless weaning is 
resorted to, more of the same indigestible food is taken, 
hence a purgative is contra-indicated. Relieve the pain 
for the sake of both mother and baby. Use paregoric, 
regretfully, until you have time to regulate baby and 
mother, and thus permanently correct the condition. This 
is in strong contrast to the pernicious use of opiates or 
soothing syrups for their temporary relief, with no meas- 
ures taken for a permanent cure. 

^ _ . Hunger is a more common trouble than colic. 

Deficient wn ., ° . .^ . r 

Quantity While occurring at any age, it is more irequent in 

of Milk the early months. A hungry baby will cry and 
Causing make mother nervous 1 and the milk soon becomes 
Hunger k a( j - n q Ua iit V) hence the two defects sooner or later 
go hand in hand. 

The previously good baby begins to cry at night and 



Hunger 35 

to sleep badly. The milk supply is always lower in the 
afternoon. He goes to bed hungry and cries dur- 
of Hunger m S me n ig nt - I* * s not necessarily accompanied 
by a loss of weight at first; he may still make his 
weekly gain, just as one may be healthy, strong, and well 
nourished on two meals daily, but sleep badly if supper 
is omitted. Of course, if the condition persists, he fails 
to make his gain, then loses. The stools may be consti- 
pated, rather small in amount, though apparently other- 
wise normal, but soon the milk becomes disordered in 
quality, the result of mother's loss of sleep, and the stools 
may consequently be green and curded. The urine is 
usually scanty. Of course, the failure to gain will soon 
be noted, but it is highly important that the condition 
should be recognized before this, as it is so much easier 
to correct in the beginning. Do not wait for a loss. Sus- 
pect it at a failure to gain. His behavior may show it; 
he cries to nurse frequently, sucks his fists, is very thirsty. 
At the nursing interval he either wants to nurse longer 
than twenty minutes or takes a few draws and begins to 
"hunch," never going to sleep at the breast. 

A mother's own feeling as to the breast supply is most 
misleading. She may be sure that she has plenty, and to 
Weigh demonstrate it, presses out a few drops after the 

A f tep ' baby has finished. This is no proof. The only 
Nursing positive way to find out how much he is getting is 
by careful weighing before and after nursing, on accurate 
scales, not necessarily the net weight, but with clothes 
and all. Do not even change his napkin should it hap- 
pen to be necessary between the two weighings. In this 
way we can find out exactly how much he gets from the 
breast. Spring scales are worthless in this all-important 
differentiation. Get a good balance scale weighing at 
least to a half ounce. Much trouble, probably a life, can 



36 Care and Feeding of Southern Babies 

be saved by determining this point early. It is impossi- 
ble to differentiate between colic and hunger except by 
this careful before-and-after weighing. Many babies are 
drugged into sleep when they are really hungry. 

If scales are not accessible, a diagnosis may be made 
by the crude method of offering him cereal water just 
after his nursing. If he takes it greedily, it indicates 
that he is not getting enough milk. 

The outlook is gloomy unless recognized early; other- 
wise the milk soon deteriorates in quality as well as 
Treatment quantity and the baby is badly upset. If we are 
for sure the deficiency is temporary, due to some slight 

Hunger illness or nervous strain on the mother's part, the 
suggestion of offering the barley water after each nursing 
may tide over until the full supply is reestablished. He 
will probably refuse the extra feeding in the forenoon 
and take one-half or all of it at the afternoon nursings. 
While not much of a food, cereal water is a filler, and 
will satisfy him. 

Unfortunately, we do not know of any drug or proce- 
dure which will permanently increase the flow of milk. 
As before suggested, the mother should live a normal life, 
take a normal diet, with a slight excess of fluids, prefer- 
ably milk or buttermilk, and should have plenty of rest 
and as much fresh air and exercise as are consistent with 
her physical strength. If these regulations have been 
adhered to, it is useless to expect any great results from 
diet or drugs. Too much fluid, be it tea, malted drinks or 
what not, while possibly temporarily increasing the flow 
of milk, does permanent harm by weakening the mother, 
as she cannot take her usual amount of more substantial 
food if constantly filled up on liquids. Besides, the 
excess may also disturb her digestion. An extra glass of 
milk or buttermilk between meals and at bedtime, with 



Mixed Feeding 37 

her normal amount of fluid at meals, is ample. The only 
way to remedy the insufficient quantity of milk is by 
mixed feeding — that is, giving some artificial food in con- 
nection with the breast. Mixed feeding has many ad- 
vantages and few disadvantages, and makes possible the 
use of every drop of breast milk. 

Mixed Feeding 

By mixed feeding is meant the use of artificial food, 
in addition to breast milk. If in spite of good hygiene 
and care of the mother, with no temporary disorder to 
explain it, it is ascertained that the milk supply is defi- 
cient in quantity, mixed feeding offers the only perma- 
nent relief, retaining the benefits of as much human milk 
as is secreted. We may consider it under two heads: 
complemental and supplemental feeding. 

Complemental feeding is the filling out of each nursing 
with a sufficient amount of artificial food. This is by far 
Comple- tne preferable method, especially for babies under 
mental four months, giving each breast the regular nurs- 

Feeding m g stimulus necessary to the maintenance of the 
regular flow. The best method of determining the amount 
to be given is to weigh carefully before and after nurs- 
ing, thus ascertaining the amount he gets, and fill out to 
proper amount. (See page 48.) This is troublesome. 
The quantity may be estimated by watching the length of 
time he nurses satisfiedly before beginning to show that 
he is working for nothing. Then give one-fourth, one- 
half or three-fourths of a full feeding, according to this 
observation. 

If this method is not satisfactory, offer a full feeding 
after each nursing, and let him take what he wants. The 
appetite is a fair guide; even if too much is taken, it will 



38 Care and Feeding of Southern Babies 

be regurgitated and no serious harm be done. The mix- 
ing of human milk with artificial food is not a disad- 
vantage, but rather facilitates the digestion of the latter. 
Supplemental feeding is giving an artificial food alone 
at one interval, allowing the breast to rest completely. 
Supple- « At the next nursing after this rest, both breasts 
mental should be given. The best time for this artificial 

Feeding feeding is at 6 P.M. This is chosen because the 
supply of breast milk is lower in the afternoon and be- 
cause it allows a full nursing, both breasts, at bedtime. 
Babies sleep better on a full nursing. There is no harm, 
however, in changing this feeding occasionally to the 
forenoon or even to the last feeding at night, should it 
be more convenient. 

It is not often permissible to give more than one sub- 
stitute feeding. The milk supply will fail unless the 
breasts are stimulated regularly. Should more assistance 
be needed, it is wiser to fill out other nursings with a par- 
tial quantity (complemental feeding) . When the breast 
supply is very low, both breasts may be given at 6 a.m., 
12 M. and 6 P.M., and a feeding at 9 a.m. and 3 and 9 
P.M., even giving a partial feeding after the nursings, if 
not satisfied with both breasts. 

Mixed feeding has many advantages: it accustoms the 
baby to taking an artificial food, which is not always easy 
Advantages to adapt. If begun before it is absolutely needed, 
of Mixed we can try one food mixture, and if it disagrees, 
Feeding g back to the breast milk, assisted possibly by 
cereal water, and straighten him out, and then try anoth- 
er. If you wait until artificial food becomes a necessity, 
the second trial must be made not upon a well baby, but 
an upset one. If the mother should become ill, she knows 
what food will agree with the baby, and complements 
each nursing. It gives the mother a chance to get out and 



Weaning 39 

makes nursing less strenuous. If the baby happens to be 
ill, the artificial food must be stopped immediately. The 
breast will probably be ample to supply the demands of 
the diminished appetite, or some harmless mixture, as a 
cereal water, may be used to fill out. 

As to choice) of food to be used in mixed feeding, of 
course cows' milk mixtures are to be recommended as 
What to most nutritious and better balanced, but when five- 
Mixed" sixths or six-sevenths of the food is breast milk, we 
Feeding need not be so particular. Cows' milk requires 
intricate care as to cleanliness, refrigeration, and detailed 
preparation, as much for one feeding as for the entire 
day's supply. This care devolves upon the mother, and 
the necessary worry frequently further diminishes her 
own supply, hence it is often best to use a prepared food, 
such as dry milk, requiring the minimum of detail in 
preparation, and no refrigeration, and which may be 
safely left in charge of inexperienced hands while the 
mother is resting. 

Weaning 

Weaning is but an extension of mixed feeding. As the 
breast supply grows less, increase the amount of artificial 
food until weaning is accomplished. 

The choice age is twelve months, beginning with one 
artificial feeding at the ninth month. Never wean sud- 
Normal denly if possible to avoid it. Do not wean during 
Time to an acute teething period nor in the summer, even if 
Wean partial nursing has to be prolonged to fifteen 

months. Entire nursing after the first year is precarious. 
Nursing, even partial nursing, after fifteen months is 
almost always harmful. Such babies are not well nour- 
ished, become nervous, poor sleepers, have capricious 
appetites, and they take cows' milk poorly. The strain 



40 Care and Feeding of Southern Babies 

upon the mother to furnish the diminished quantity at 
this age is even greater than when giving a bountiful 
supply. 

In weaning, it is sometimes very difficult to train a 
baby to take cows' milk in any form without starving him 
into it. Condensed milk seems more readily taken than 
any other form of artificial food, and by gradually re- 
placing the condensed with cows' milk, we can change to 
the latter. Sometimes it is necessary to use flavorings, 
such as salt, vanilla, nutmeg, or even tea or coffee in the 
food to induce him to take it, of course, gradually reduc- 
ing the flavoring so that within a week it is given plain. 
Buttermilk may be well taken when other forms are 
refused. If the baby is old, enough to take starch, the 
milk may be poured over bread crumbs or cereal in a 
saucer, and the amount of crumb or cereal gradually 
reduced. One or two feedings may be forced. (See page 
87.) He may take it well after once getting accustomed 
to it. 

It is usually unsuccessful to attempt to train babies to 
take a bottle and nipple after seven months of age. Bot- 
tles are an additional care and best dispensed with. Their 
only advantage is that a baby will take a bottle and go 
to sleep on it, but must be wide awake to be successfully 
fed from a cup or spoon. 

Wet Nursing 

Successful wet nursing throughout infancy is so rare 
nowadays that it would hardly be reckoned as a method 
of feeding. Wet nurses are to be used only for upset 
babies. Get them straight and then, by a process of grad- 
ual weaning, adjust a suitable milk mixture. Thus a 
single wet nurse has served to adjust twelve sick babies 
in one season. 



Wet Nursing 41 

Your physician should be consulted in the selection 

of a wet nurse, and should make a careful examination, 

Examina- Dot h °f mother and babe, to exclude syphilis and 

tion of Wet tuberculosis; then be sure that your baby really 

Nurse gets the amount he needs from the foster-mother, 

by carefully weighing before and after nursing. 

It is better to draw out the milk and feed it, for thus 

we know how much he gets. Milk so withdrawn will 

Withdrawn keep on * ce J ust as cows ' milk. It may be pasteur- 

Human ized, if suspicious. There is no reason why the wet 

Mi |k nurse's baby should correspond in age to your 

baby. He should, however, be not less than two weeks 

old nor over one year old. Superstition among Southern 

wet nurses prevents many an ignorant foster-mother from 

giving milk to a baby of the same sex as her own. Of 

course, this is groundless, and you may tell her that if 

the milk is withdrawn it will do her own baby no harm. 

Examination of the milk will show its quality, though 
the healthy condition of the wet nurse's baby is the best 
testimony. Milk examinations are misleading. 
Milk x- j^ fi rst m ilk drawn may appear very blue and 
poor, but the strippings, or the last drawn, are 
much richer, and the mixture may be satisfactory. A 
liberal specimen should be sent to the laboratory to get 
reliable results. There is no harm in having the milk 
from several wet nurses. It is more apt to be an aver- 
age, just as herd milk is more uniform than the milk 
of one cow. A wet nurse with a dead baby is rarely 
satisfactory. 

There is little or no danger of contracting syphilis or 
tuberculosis in milk so withdrawn and fed to the baby. 
Infection The syphilis germ is of feeble vitality and does not 
Through live long in milk, especially if kept on ice. Tuber- 
Wet Nurses cular mothers are not likely to have enough milk 



42 Care and Feeding of Southern Babies 

to draw out. Syphilis is contracted by getting the blood 
from a sore nipple into an abrasion on the child's mouth; 
tuberculosis, by the child inhaling the breath of the tuber- 
cular mother while at the breast. These are strong rea- 
sons for preferring the method of feeding milk drawn out 
instead of putting the child directly to the breast. 

When using a wet nurse, it is your duty to see that her 
baby is not suffering from the deprivation. For the sake 
of all concerned, see that he is well fed and healthy. 

Artificial Feeding 

It is with extreme diffidence that this subject is ap- 
proached. It is not one that can be dealt with super- 
F r ficially. Each baby is an individual proposition, 

Normal requiring a special modification. Human milk, con- 

We, J taining human fats, proteids, sugar, and salts, is 

Babies j 3U -j t £ or ^ DaDV) an( j tne baby's digestive power 

for it, and the problem of substituting a mixture, even 
though containing the same elements, is a difficult one, 
often taxing the skill and patience of the most experienced. 
In spite of science, the question is one concerning which 
we are woefully ignorant. The only justification for dis- 
cussing it here is that unless some idea of feeding normal 
babies is given, they might be put upon a patent food; 
often an unbalanced, unsatisfactory nourishment, sooner 
or later to be followed by disorders of nutrition. The 
following directions are only for normal well babies ; the 
care of others demands experience. 

The best available substitute food for any baby under 
one year of age is cows' milk, in some of its varied forms. 
Human and cows' milk are both mixtures of fats, pro- 
teids, sugar, and salts in water. 



Milk 43 

Pro- 
Fats teids Sugars Salts Water 

Human milk 4% 1%% 7% \% 87+% 

Cows' milk 4i/ 2 % 3i/ 2 % 4% £% 87+% 

Human milk contains nearly twice as much sugar as 
cows' milk, practically the same amount of fats, and 
about one-third as much proteids, and only one-third the 
amount of salts. 

One striking feature of the analysis of the milks of all 
animals is that they contain nearly 90 per cent water, 
impressing the necessity of dilution in food for the young. 
Fats are found in milk in the form of cream, used to 
maintain body heat and to promote the growth of bone. 
The proteids 1 are the curds of milk. Their function is to 
sustain life and growth. Sugar exists as milk sugar. It 
produces body heat and stores up fat in the tissues. It 
was once thought that by modifying cows* milk so as to 
make the same chemical content as human milk, the prob- 
lem of infant food would be solved, but this is far from 
true. Baby's digestion shows a decided difference be- 
tween cows' fats and human fats, also in the proteids and 
even the sugar. Each of these elements must be consid- 
ered as new substances as far as the particular baby is 
concerned, and adjusted to suit his digestive strength. 

The first necessity is to obtain good milk. Always get 
the best available. Rich Jersey milk contains too much 
fats, frequently as much as 5 or 6 per cent, but 
Emm? this defect is easily remedied by removing the 

cream after it stands an hour, or possibly two, if 
over-rich, or, if delivered in bottles several hours after 
milking, when the cream has separated, pour off a por- 
tion of it. Herd milk is preferable to the milk of one 
cow, as it is less likely to vary with conditions affecting 
that one, though if it be a choice between old herd milk 



44 Care and Feeding of Southern Babies 

and perfectly fresh one cow's milk, the preference should 
be given to the latter. 

The cows should be healthy and tested for 
The Dairy tuberculosis. The milk barns and milkers should 
be clean and sanitary, and comparatively free from 
flies. 

As soon as possible after being withdrawn, the milk 
should be put into sterile bottles and kept at a tempera- 
ture of 50 degrees until delivered to the consumer's 
M^k house; it should then be at once placed in the re- 

frigerator. The best milk will rapidly deteriorate 
if allowed to stand on the doorstep in the hot sun for 
even a quarter of an hour. Many cities now superintend 
their milk supply, demanding tubercular tested cows, 
clean dairies and dairy barns, and a comparatively low 
bacterial count of 150,000 to 200,000 to the one-fourth of 
a teaspoonful, which means that the milk has been pro- 
duced under good general conditions and carefully han- 
dled. 

Certified milk is accessible in larger cities. It must 

have a bacterial count of not more than 10,000 to the 

one-fourth of a teaspoonful, which means that 

Certified scrupulous cleanliness, approaching even surgical 

asepsis, has been observed in its preparation and 

that the dairy has been under the supervision of a milk 

commission. 

To sterilize milk it must be boiled at least three min- 
utes. This kills the bacteria, coagulates a part of the 
proteid, and with it a little cream rises and forms 
Sterilizing a scum f^Q S p 0res or e gg S f some of the bac- 
teria are not killed. Sterilized milk will keep even 
off of ice for twenty-four hours. It is free from living 
germs, and only spoils when these eggs or spores germi- 



Preparation of Food 45 

nate. Sterilized milk does not sour, as the acid-forming 
germs have been killed, but it rots, hence you cannot 
expect the sour taste in old sterilized milk. Sterilized 
milk coagulates in the stomach in smaller lumps than 
unboiled milk. It is constipating, and also lacks fresh- 
ness. 

Milk is pasteurized by holding it at a temperature of 
140° to 150° for ten minutes. While this kills the germs 
as well as sterilizing does, it has the advantage of 
Pasteur- not f orm i n g the cream scum, and also of not com- 
pletely removing the freshness. Boiling, however, 
is surer and safer. Commercial pasteurization is not 
reliable, as it is too often used as a method of market- 
ing milk which otherwise would be sour from age. 

The Preparation of the Food 

In the following directions, effort has been made to be 
as simple as possible. Every word has been carefully 
studied and the directions must be followed minutely. 

Directions for Bottle Feeding 

A separate bottle for each feeding. Cylindrical bottle 
with narrow neck, no corners, is best. 
Articles Wire rack for holding bottles upright. 

Recom- Several nipples. Holes should be large enough 

mended to allow a feeding to be finished in ten or twenty 
minutes. When bottle is inverted milk should slowly 
drip. Holes may be enlarged with hot needle. Nipples 
should be kept in covered dish containing borax solu- 
tion — heaping teaspoon to one-half pint of water. 
Glass or enameled pitcher. 
Glass funnel for filling bottles. 
Pint glass graduate. 






46 Care and Feeding of Southern Babies 

Long bottle brush. 
Tablespoon, borax, and cotton. 

Get best, freshest milk possible. Ask city health officer 

if your dairy is satisfactory for baby feeding. Put bottle 

on ice immediately upon its arrival. Prepare twen- 

Milk ty- four-hour supply at one time, which includes 

the first feeding for the next day. Be systematic; 

it is easier, quicker, safer. Use unopened bottle of milk. 

Pour into pitcher to mix cream. 

Milk, ounces. 

Water, ounces. 

Sugar, leveled tablespoons. 

Boiled — Unboiled. 

Feed ounces every hours, at A. M., P. M. 

When boiling is ordered, bring required amount of 

water to boil in saucepan, add milk and boil actively for 

three minutes, stirring to prevent scum forming. 

M ( ? | l k ms Add sugar after removing from stove. Pour into 

clean feeding bottles. Stop with cotton. Put in 

bottle rack and set in cool water in summer or in open 

air in winter. As soon as cool, put on ice. 

If milk is not to be boiled, dissolve sugar in 

Unboiled boiling water, cool, and add ice-cold milk; divide 

into bottles and put on ice. 

Before feeding, heat bottle to blood heat by placing 

it in hot water. Test heat on bare forearm; never put 

nipple in your own mouth. Watch or hold baby 

Feeding during entire feeding time. This should be from 

ten to twenty minutes. If taken in shorter time, 

get nipple with smaller hole. If not all consumed in 

twenty minutes, throw remainder away and wait until 

next feeding time before giving more. Then use nipple 

with larger hole. 

Immediately after finishing feeding, wash bottle with 



Preparation of Food 47 

brush and washing powder, rinse thoroughly, fill full 

Care of w * tn horax water, and allow it to stand until next 

Bottles and morning's feedings are prepared; then rinse bottle 

Nipples an( l drain while feedings are being made. This 

obviates the necessity for boiling bottles. 

New nipples should be boiled one time before using. 
After each feeding they should be cleansed immediately 
with soap and water, rinsed, and kept in covered glass jar 
containing borax water, heaping teaspoon to half pint. 
Rinse off borax water before using. 

Wide-mouthed bottles are good only for careless moth- 
ers. The large nipples are unsatisfactory and more ex- 
pensive, and notwithstanding their breast shape, are not 
easily taken by young babies. 

Food and water should be given warm. In summer, 
babies over six months of age may, if they prefer, take 
them cool, but never ice cold. 

Note that the directions obviate the necessity for daily 
boiling of bottles and nipples. Boil them once, as they 
come from the shop. Put only clean food in them, wash 
them immediately after feeding, and fill with a mild anti- 
septic. If, as is too often done, the finished or half- 
finished bottle is carelessly set aside, the dry milk scum 
hardens, germs multiply rapidly, and the only way to 
clean such a bottle is to boil it. 

The use of a separate bottle for each feeding is strongly 
urged, as in this way alone will the equal amount of 
cream be taken. If separate bottles for any reason are 
not practicable, keep the entire quantity in a large glass 
jar (have two of them and use on alternate days, boiling 
one daily). Before removing the food from the jar, mix 
the cream thoroughly with a sterile spoon. 

Watch the baby through each feeding to see that the 
nipple does not collapse nor the bottle tilt over. 



48 Care and Feeding of Southern Babies 

As in breast feeding, the interval best suited to the 
average baby is three hours, the feedings coming at 6, 9 
a.m., 12 M., 3, 6, 9 p.m., and 2 a.m., up to four 
FeecTnci months; and after four months, or earlier if sleep- 
ing well, omit the 2 A.M. feeding. Wake for every 
other interval, but not for the midnight feeding, and when 
this is to be discontinued, do it by lessening the amount 
one ounce each night, finally giving only warm water. 
At eight months, the four-hour interval may be started, 
feeding at 6, 1Q A.M., 2, 6 and 10 p.m. Better, keep the 
three-hour interval and discontinue the 10 P.M. feeding, 
giving five feedings, at 6, 9 a.m., 12 M., 3 and 6 p.m. 

Artificially fed babies get so much water in their 
Water food that there is usually little need for giving 

extra water. On hot days, however, it is well to 
offer it frequently. 

The rule is to give one or two ounces more than 
months of age. A hungry baby at birth — no months old — 
Quantity w i^ ta ^ e two ounces, while a weak one will be 
at Each satisfied with one ounce. At four months, give 
Feeding £ ve or s j x ounces, increasing the quantity grad- 
ually — that is, one-fourth ounce each week. Do not wait 
until he is a month older and then add the whole ounce. 
For instance, at four and one-fourth months, give him 
five and one-fourth ounces, or six and one-fourth ounces. 
The maximum quantity of fluid given at any age is eight 
ounces, rarely ten, never more. Too much fluid over- 
distends the stomach. 

Up to three months, whole milk diluted with equal 
parts of water is sufficiently strong; from three to six 
months, two-thirds whole milk and one-third water ; 
f r |\/nk fr° m s * x to eight months, three-fourths whole milk 
and one- fourth water; after eight months, undi- 
luted milk may be given, though during the summer three- 



Preparation of Food 49 

fourths is more satisfactory and safer, even up to the end 
of the first year or longer. In these directions, "whole 
milk" means no cream added and none removed. 

The use of cream or top milk is not advised. Attempts 

to force babies to gain by the use of over-rich milk, in 

our climate, usually end in disaster. Efforts to 

Cream correct constipation with cream are dangerous and 

usually unsuccessful. 

Sugar is not a condiment, but a real food, to be used 
not haphazardly, but with great care, as in it there are 

possibilities of success or failure. The addition of 
Sugar sugar now completes the food. The choice of 

sugar with normal babies is a matter of personal 
preference. Most well babies will thrive on any form. 
Milk sugar, identical with that in human milk, would seem 
the natural selection, and is widely used in the East, but 
in our section gives no better results than cane sugar, 
which is cheaper, more accessible, and less likely to be 
adulterated, and for this reason is suggested in all ordi- 
nary cases. Malt sugar may be used, if while taking 
cane or milk sugar the baby fails to gain, even though 
apparently well. It is also indicated when the stools 
with other forms of sugar are whiter than normal. It 
may relieve constipation in normal babies. The quantity 
of sugar to be added to each twenty-four-hour food mix- 
ture is one ounce up to four months, and after four 
months, one and one-half ounces. As soon as starch in 
the form of bread and cereal is given, sugar may be 
gradually omitted. Two level tablespoons of cane sugar, 
three of milk sugar, or four of malt sugar make 
one ounce. Use it carefully, never judging by the taste. 

The use of lime water is so common that some mention 
must be made of it. I am convinced that it is but a habit, 

—4— 



50 Care and Feeding of Southern Babies 

perhaps doing no harm, but at any rate unnec- 
Water essary in the average case. Milk supplies at least 

four times the quantity of lime required for bone 
formation, hence to simplify, let's leave it out. Its 
action is to retard the curdling of milk in the stomach. 
It is indicated only when vomiting is a prominent fea- 
ture, and then it must be added to the extent of one- 
fourth or one-half the feeding. 

Example — To make the food for a strong five-months 
baby: He should have six feedings at three-hour inter- 
vals, and the quantity at a feeding should be his 
Examples age in months plus two; that is, seven ounces — 
this makes forty-two ounces in the whole twenty- 
four-hour mixture. The strength should be two-thirds 
whole milk, one-third water ; the sugar should be one and 
one-half ounces. Take twenty-eight ounces of milk, four- 
teen ounces of water, and three level tablespoons of cane 
sugar, divide into six bottles and give at 6, 9 A.M., 12 M., 
3, 6 and 9 p.m. 

To make the food for a frail two-and-one-half-months- 
old baby: He should have seven feedings of three and 
one-half ounces each — his age in months plus one. The 
twenty-four-hour quantity is twenty-four and one-half 
ounces, which must be half-strength milk with one ounce 
of added sugar. 

Milk, twelve and one-fourth ounces. 
Water, twelve and one-fourth ounces. 
Cane sugar, two level tablespoons. 
Mix and boil and divide into seven feedings. 
The caloric values of the given formulae have been 
carefully studied and fulfill all requirements. While 
possibly the fat content is a little low in the early 
w°? months, it is safer to use a diminished amount of 

cream for young babies. 



Starting Artificial Food 51 

Boiled milk is safer. It forms softer, smaller curds, 

is more digestible, prevents tubercular, typhoid, or other 

infections. It is more easily preserved. After May 

B ^l\l^ g 1st, milk for all babies must be boiled. Its only 

faults are its constipating tendency and lack of 

freshness, and these are easily corrected by a few drops 

of milk of magnesia and orange juice. 

Starting a Baby on Artificial Feeding 

In mixed feeding, when only one artificial feeding 
daily is required, the full strength food may be begun at 
once, but if weaning is sudden, the child must be grad- 
ually accustomed to his new food, using half the pre- 
scribed strength, with some of the cream removed and no 
sugar added. The milk should always be boiled. 

To suddenly wean a five-months baby, allow the milk 
to stand one hour and take off the cream then risen. 

Take fourteen ounces of this milk, twenty-eight 
Example ounces of water, boil, and add no sugar. This 

makes six feedings of seven ounces each. The 
third day, add one level tablespoon of cane sugar, and 
daily increase two ounces of milk and decrease two ounces 
of water in twenty-four-hour mixture. In three or four 
days, if all goes well, add one more level tablespoon 
of sugar, and in nine days he will be using twenty-eight 
ounces of not rich milk, fourteen of water, with two level 
tablespoons of sugar; one more tablespoon of sugar is 
now added, and then the cream gradually left on, thus 
reaching the required strength for this age. Continue 
boiling if it happens to be summer. If the food is re- 
fused on account of the lack of sweetness, use saccharine 
tablets, which take the place of sugar as a sweetening, 
but do not cause fermentation. Obviously, with such 
weak rations, the required weekly gain will not be made, 



52 Care and Feeding of Southern Babies 

and possibly the baby will be hungry, but it is not safe 
to try to satisfy with a food which has not yet been ad- 
justed. The stools should be carefully watched for signs 
of indigestion. 

It is a desperately hard task to feed a new-born baby, 

but fortunately rarely necessary, as there is usually 

».,.,„ _ enough breast milk to begin with. From the pre- 
Startmg a ,. D , r ^ • 1 i i 

New-born ceding description 01 the process with an older 

Baby on baby, it is seen that each element of food is to be 

Artificial tried as nearly as possible separately, starting with 

a weak boiled milk with the full amount of proteid, 

no added sugar, and little fat. 

During the period of experimenting, loss of weight is 
inevitable. If the new-born baby is small or frail, he will 
not be able to survive further depression. Under such 
circumstances, do not risk artificial feeding, but give at 
once human milk until his digestion is strong enough to 
undertake the adjustment of cows' milk, which process is 
even slower and more hazardous than with older babies. 
If, however, he appears sufficiently strong after twenty- 
four hours on plain water, giving one ounce every two 
hours, begin with one-fourth strength boiled skimmed 
milk, no sugar, making up ten feedings for the twenty- 
four hours. Give two ounces every two hours during the 
day, with one feeding after 10 p.m. Prepare five ounces 
of milk and fifteen of water. Then add one-half ounce of 
skimmed milk and decrease one-half ounce of water daily 
or every other day until half-strength milk is reached. 
Sugar is to be added gradually until you reach the allot- 
ted one ounce in twenty-four hours' supply, and the 
cream gradually increased until full milk is used; then 
go to the three-hour interval, with, of course, seven feed- 
ings in the twenty-four hours. The whole process will 
take from two to four weeks, during which time the 



Successful Artificial Feeding 53 

weight, stools, and temperature must be carefully 
watched. 

If the feeding is progressing properly, baby 
Successful should gain at least one-fourth of a pound weekly, 
Artificial should sleep well day and night, and have normal 
stools and normal appetite. 
For emphasis it must be repeated that the above meth- 
ods are simply working rules and that most normal babies 
will digest the given mixtures if gradually adjusted, and 
if the amounts stated are reached, the child will be thor- 
oughly nourished and with a balanced ration. 

Many babies refuse to conform to rules, — making each 
feeding case individual. 

An excess of fats or sugar or proteids does not signify 
more than four per cent fats or more than the specified 
amount of added sugar, but it means that the baby is 
getting more than he can thoroughly digest, as shown by 
the before mentioned symptoms. Hence the necessity of 
small beginnings in experimenting with artificial feeding. 
Some babies throughout the first year are unable to take 
whole milk and some cream must be removed; others may 
be unable to digest any added sugar. Each may have an 
idiosyncrasy. 

Unsuccessful feeding is a condition which should have 

the attention of the best available specialist in baby feed- 

Unsuc- m g^ The natural tendency of such disorders is 

tificial "*" f rom ^ ac l to worse. It is not likely to be corrected 

Feeding unless a radical change is made. 

Failure to gain (don't wait for a loss); poor sleep; 
irregular appetite; chronic vomiting or spitting up, or 
Symptoms abnormal stools show that the feeding is not suc- 
Indicating cessful. Stools show the progress more satisfac- 
Disturbed torily than any other indication. They represent 
Nutrition ^ reaction of food to the digestive process. Thus 



54 Care and Feeding of Southern Babies 

only can the strength of digestion be observed. The 
mother should be able to detect the slightest deviation 
from normal. 

In cows' milk feeding, the stools are lighter, rather a 
lemon than an orange color, and are more consistent 
than in breast-feeding; rather mushy, possibly 
Stools slightly formed; in number, one to three daily. 

If cereal water or malt sugar is used in the prepa- 
ration of food, they are oak brown. 

Too much sugar produces green, acid, chafing 
Excess of stools, accompanied by a great deal of gas. Nor- 
Sugar ma l stools may turn green after standing, but this 

is not significant. 

Too much fat causes either soft, bean-shaped 
Fats SS ° cur d s m loose, frequent stools, or putty-like, dry, 
whitish stools, with a tendency to constipation. 
The whitish tendency is a danger signal. 

Too much proteid shows in large, hard, white 

Protends curo ^ s J probably too many stools, associated with 

colic. 

Blood and mucus in stools call for medical attention. 

Severe constipation with hard lumps may cause a little 

Blood and mucus 5 possibly a streak of blood. This is not 

Mucus serious, but the consistency must be changed. (See 

Constipation, page 77.) 

Some drugs affect the color. Bismuth and iron 

Drugs cause blackish stools; castoria, a dark brown; 

milk of magnesia produces a watery stool. 

When other foods than milk are given, the color is 

more variable. Grape juice, spinach and other green 

vegetables may cause blackish stools; meats, meat 

Food broths and eggs cause darker stools with a foul 

odor, especially if they are in excess. Bread and 

cereals produce a brown color. 



Other Foods than Milk 55 

Other Foods Than Cow's Milk 
During the First Year 

Milk is the baby's living the first year; he requires 
nothing else, and is liable to be injured rather than 
helped by premature additions to the diet. 

Goats' milk has the same characteristics and about the 
same formula as cows' milk. It can be had fresh, as 
Goats' the animal may be kept on the premises, and fre- 

Mi ,k quently agrees when impure cows' milk fails. 

Mares' Mares' milk (or asses' milk) is more digestible 

Milk than cows' milk, but is difficult to obtain. 

When the first year is mentioned, naturally the average 
baby is referred to, not an abnormally precocious nor an 
Progress of abnormally retarded one. Personally, the author 
Teeth as regards the teeth as a better standard of digestive 
Indication strength than age. At one year, there should be 
for Food £ our U pp er incisors and two or four lower incisors, 
and this rather than a birthday should indicate the time 
to begin solid foods. It would be less hazardous and 
more beneficial, for instance, to start a one-year diet with 
an eight-months baby with six teeth than with a fifteen- 
months baby with only two teeth, not an unusual condi- 
tion. While scientifically proved that starch may be 
digested even by a new-born baby, yet it should not enter 
into his dietary in the form of bread and cereals in ap- 
preciable quantities until he has six or eight teeth. 

The following articles of food are sometimes indicated 
under one year. Strictly speaking, they are not foods, 
but are intended for some special purpose: 

Strained orange juice. This should be given regularly 

to babies fed on boiled or pasteurized milk or canned or 

dried food. It supplies freshness not otherwise 

Juice obtainable. It may be begun as early as three 

months, given half way between feedings in increas- 



56 Care and Feeding of Southern Babies 

ing quantities, one to six tablespoons daily, depending 
upon the condition of stools. Even when fresh milk is 
taken, fruit- juice is beneficial. The orange is always to 
be preferred, but if not obtainable, the juice of fresh 
grapes or a reliable brand of preserved grape juice 
diluted half and half may be used. Weak lemonade is 
satisfactory with older babies. The quantity given must 
be governed by the condition of the stools. 

Cereal water (barley, rice, or oatmeal water) may be 
used instead of plain water in making milk mixtures. Its 

food value is slight, almost negligible, but it makes 
Water tne m i xture more palatable, assists in reducing the 

size of the milk curd, and may correct constipation 
by decreasing the firm texture of the stool. 

Beef juice may be given in small amounts to anaemic 
babies after the sixth month. Its food value is but slight, 

but it acts more as a tonic, supplying the salts of 
j. iron. One to three tablespoons may be given with 

one feeding. Gravy is never so satisfactory as 
beef juice. It is often indigestible, containing too much 
cooked fats and seasoning. 

After ten months, a toasted cracker, not sweetened, or 
toasted bread may be given for ten minutes before or 

after a nursing or feeding. The baby chews and 
Breads sucks on it and seems to enjoy it, and sometimes 

thrives upon it. There is no worse habit than con- 
stantly sucking a cracker or bread, hence limit the time he 
is allowed to have it rather than the amount. Watch 
him carefully while taking the bread to prevent choking. 
Beef juice may be given on the crumbs. 

Patent Foods 

It is difficult to discuss patent foods impassionately, so 
much is the harm done by their indiscriminate use. Many 



Patent Foods 57 

babies are forced to rely upon these foods simply 
Patent because those to whom their welfare is entrusted 

have never made a study of infant feeding, finding 
it easier to follow the printed directions on the container. 
There are two kinds of patent foods: The complete 
(requiring only the addition of water), all varieties of 
which contain dry or boiled-down milk in some form; 
and the incomplete, which are to be mixed with cows' 
milk. The patent part of both kinds is the added sugar 
or starch, sometimes a drug in addition. They all go to 
the cow for their cream and proteid, either in the form 
of concentrated or fresh milk. 

Complete foods are those requiring only the addition of 
water. Concentrated milk in some form is the basis. As 
Complete tne cream is not easily preserved, skimmed milk 
Patent must be used in their manufacture, so all are de- 

Foods ficient in fat. Sugar or starch or both are added 

to this milk basis to make the food. They all contain an 
excess of sugar, with but little fats. They rely for their 
success on the fact that some babies (about half of them) 
can successfully take an excess of sugar, and make fluffy, 
fine looking specimens, though they are not healthy and 
offer little resistance to disease. Holt has stated that he 
has never seen a baby fed one year on such foods without 
rickets or scurvy, one or both. This is corroborated by 
my experience, though babies do not often wait a year to 
show symptoms. 

Sweetened condensed milk is an example of this form, 

though strictly speaking not a patent, being made by 

many manufacturers. Every teaspoon contains 

Condensed about three-fifths of a teaspoon of sugar. If a 

child happens to be one who can digest the excess 

of sugar and make it answer for fat, he grows in weight; 

if not, he soon shows one or more symptoms of sugar 



58 Care and Feeding of Southern Babies 

indigestion: flatulency, loss of appetite, vomiting, chafing 
diarrhoea. 

If complete patent foods disagree, sugar must be the 
offending ingredient, so it is senseless to change from one 
form of these foods to another, as all have the same high 
sugar content, varying only in the character of sugar or 
starch. If one kind of sugar disagrees, other forms 
will also. 

Complete foods are often successful in starting a baby 
when only a small quantity is used — a teaspoon or so — 
but when increased to satisfy the increasing appetite, 
they usually cause symptoms of sugar intolerance. 

These are sugars with or without starch, and occa- 
sionally a drug or some inert substance as egg albumen 
Incomplete mixed. The real nourishment comes from the pro- 
Patent tein and fat in the cows' milk added. Some of 
Foods them are good sugars, probably the best on the 
Those to market, but are sold under patent names at greatly 
be Mixed increased prices. The directions with all forms of 
With Milk p atent f ooc l s advise the use of excessive quantities. 
Few babies can digest so much sugar. 

Two forms of milk not in such general use should be 
mentioned: dry milk and evaporated milk. The first is 
Dry Milk skimmed milk, evaporated to a dry powder by a 
and Evap- special process. There is no added sugar and it is 
orated quite satisfactory for temporary use when fresh 

1 milk is unobtainable or unreliable. One level 

tablespoon of dry milk to one ounce of water makes 
one ounce of skimmed milk. It needs no cooking, no 
refrigeration, and sugar may or may not be added, as the 
case requires. Evaporated milk or unsweetened con- 
densed milk is a thick liquid made by boiling down milk 
to one-half or one-third its original volume, with no 
added sugar. It can be converted into a weak milk by 



Patent Foods 59 

replacing the water boiled out; that is, by adding twice 
the quantity of water. It is far superior to sweetened 
condensed milk as a baby food, though it is not so easily 
preserved. When opened, it should be poured into a 
sterile glass jar and kept on ice not longer than one day, 
whereas with the same precautions condensed milk may 
be used five days. Evaporated milk is sold in very small 
cans and one will hardly last a day. 

The bad points in patent foods are the deficiency of 
t fats, the excess of sugar, and the lack of freshness. They 
do not furnish a balanced ration. Even apparently 
taqesand we ^ nourished babies show a lack of resistance to 
Disadvan- disease and defective bone formation. These foods 
tages of have their good points also: as a rule they are 
Patent sterile, are better than bad milk and are safer 

with ignorant or very poor mothers who do not 
understand the importance of clean milk or who cannot 
afford ice. For traveling babies, they are better than 
indiscriminate dining car or hotel milk. In mixed feed- 
ing sometimes a patent food is advisable on account of 
its convenience and slight tax upon the mother's time. 
Of course, it is not so nutritious as cows' milk, but if five- 
sixths or six-sevenths of the baby's food is good breast 
milk, but little harm comes from the diminished nutrition 
in using one feeding of preserved milk. 

In late spring or early summer, coincident with the 

clover pastures' growth, cows' milk becomes unreliable. 

Changes in Babies get sick and have digestive disorders in 

Milk in spite of unquestionable milk supply. The reason 

Summer for this has never been fully explained. It is the 

beginning of the hot weather, with its attendant digestive 

depression. Many of the cows are sick with diarrhoea; 

frequently they die of clover bloat. The prevalence of 

feeding disorders and bowel troubles in babies under 



60 Care and Feeding of Southern Babies 

these circumstances may be due to the transmission of the 
diarrhoea germ from the cow to the milk or to faulty milk 
secretion by the sick cow, or possibly to the transmission 
through the milk of some purgative principle taken in 
the food. 

Uncertain as to the cause, we can only suggest relief. 
Boiling the milk may modify this tendency to disagree, 
so begin May 15th to boil milk. Feeding cows on dry 
food or short pastures is a surer plan, but rarely feasible. 
During the first few weeks of this susceptible season, 
until pastures are mature, it is not a bad plan to use some 
of the preserved milks, such as dry or evaporated milk, 
thus obviating these changes. The preserved milk may 
be diluted to equal ordinary milk and used in completing 
the food formulae. Such feeding necessarily will be low 
in fats, but at this season of the year it is safer to feed a 
low fat, as babies need less in hot weather. 



CHAPTER III. 



FEEDING AFTER THE FIRST YEAR 

Feeding in the Second Year 

Up to the end of the first year, milk supplies all the 

average baby needs and in a balanced ration, lacking only 

Feeding tne sa l ts °f iron ; ana * to make up for this defici- 

in Second ency, a surplus of iron sufficient for the first year 

Year i s stored in the system at birth. After one year, if 

he gets nothing but milk, anaemia and undernourishment 

are the natural result; it is, therefore, necessary at one 

year for the average child, no matter how thriving, to 

have other foods than milk, though it should form a part 

of his diet for two, preferably five, years. 

Enough food calories may be given with perfect safety 
without milk, but it is too concentrated, and babies under 
two years, often under five, fed without milk, have 
periodic digestive disorders, so-called bilious spells, be- 
cause too little fluid is taken. Few children know how to 
drink enough water. They take it often, but only a sip 
at a time, the total quantity possibly being only two 
glasses a day. A one-year-old gets forty ounces (five 
glasses), or more, of milk, which is nine-tenths water, 
and when milk is discontinued, his fluid requirements are 
seriously endangered. He needs milk as a diluent of the 
solid food if not as a nutrient. The first solids are often 
enticing, and there is a tendency to stop liquids and take 
solids. Guard against this error. He may take the solids 
in addition to the milk, but not in place of it. 

At one year a child should be taught to take milk from 
a cup instead of a bottle, but do not change if it tends to 



62 Care and Feeding of Southern Babies 

Weaning make him neglect milk. Weaning may be accom- 
from the plished by filling a small cup from his bottle 
Bottle and coaxing him to take it thus, and gradually 

increasing the amount so given. The bedtime bottle may 

be retained another year if it helps him to go to sleep. 

At some meals cocoa or postum may be used to flavor 

milk, but this is rarely necessary. 

On the other hand, some few children refuse solids. 
Having been previously so often warned against them, it 
may require some tact to persuade them to eat. 

All new foods are experiments and should be tried 
carefully and gradually. Never add two new things to 
the dietary the same day. 

Most authorities advise the four-hour interval, begin- 
ning at eight months, giving five feedings, at 6 and 10 
Number of A.M., 2, 6 and 10 P.M., up to the end of the first 
Meals Dur- year, when the last feeding is omitted, leaving only 
ing Second four meals. Now, each baby is a rule unto him- 
Year self, and he tends rather to overeat than to starve. 

Three meals daily may suit some children, five meals 
others, and four others. Study the child. If fed too 
often, the appetite will fail ; if not often enough, he will 
be too hungry, and eat too rapidly and too much at meal 
time. If a late riser, breakfasting at 8, there is little op- 
portunity for more than four meals. There is no harm in 
making the interval four hours between some meals and 
three hours between others. In the average case, contrary 
to most authorities, I recommend five meals daily, with 
the three-hour interval. It suits most babies just as well 
if not better than the longer interval. The mid-morning 
and mid-afternoon lunches are made lighter than the 
other three meals, yet they keep the appetite from being 
too ravenous, especially for supper, when overeating 



Feeding in Second Year 63 

would make him sleep badly. The five-meal system is 
certainly more convenient to the mother, as it throws the 
three large meals with hers, so that there is no need for 
extra preparation, coming at 7 and 10 A.M., and 1, 4 
and 7 P.M. 

The first addition is bread. Any well-done or stale 
bread, preferably toasted to insure its being thoroughly 

cooked, agrees with babies. Nothing is worse than 
Breads a mass of underdone starch. Bread may be taken 

dry or crumbled in milk. Beware of sweetened 
breads, such as sweet zwiebach or graham crackers; they 
are cakes. Bread may be given for ten minutes before or 
for ten minutes after the milk. Do not allow baby to 
form the pernicious habit of continually sucking a crack- 
er, hence the time limit instead of the quantity specifica- 
tion. The bread should be crisp enough to break into 
crumbs in the process of biting with the few teeth, or 
should be stale or toasted, so as to retain its porous struc- 
ture, permeable to the digestive juices after swallowing. 
Until accustomed to taking bread, watch him to prevent 
choking. 

Cereals are next to be tried. Thoroughly cooked ce- 
reals only are permissible in the first and second years. 
Rice, grits, strained oatmeal, or cream of wheat, 
Cereals cooked at least two hours, may be used. Always 
give the cereal salted, not sugared. Put baby's 
milk, not cream, over it. The benefit derived from 
cereals is much overestimated. They are starches, and to 
insure proper digestion should be thoroughly masticated 
in order to mix them with the saliva, which is rarely 
done; and they are too often loaded down with sugar. 
Do not concentrate on cereals, even with older children. 
Uncooked cereals are questionable, certainly not permis- 
sible in the second year, though cornflakes or shredded 



64 Care and Feeding of Southern Babies 

wheat biscuit are preferable to the undercooked cereals 
procurable in hotels and dining cars. 

Crisp breakfast bacon powdered and mixed with bread 
crumbs is valuable as an appetizer, and for the salts it 
contains. It rarely fails to agree. Beef juice is a 
Meats good tonic, and contains mineral salts, but gives 

little nourishment. Scraped steak may be given in 
the second year in cool weather. It is six times as nutri- 
tious as the same amount of beef juice, and almost as 
easily digested. Tender chicken, roast beef, or mutton cut 
fine may be given after the age of eighteen months. 
Fish, if known to be fresh, may be given at the same age. 
Pork should not be allowed before the sixth year. 

The digestibility of an egg is always an individual 

proposition and must be experimented with carefully in 

every case. When it agrees, it is a valuable food. 

Eggs The white alone is so low in food value that it 

forms no part of a well baby's diet. Coddling is 

the best way to prepare it. If this is distasteful, try the 

yolk of an egg, boiled twenty minutes (through the pasty 

into the mealy stage), mash with butter and spread on 

bread. 

Vegetables are not permissible in the summer dietary 
of Southern babies under three years, and must be given 
with great care even then. Potatoes in the sum- 
Vegetables mer are liable to be too old and sprouty, or too 
immature and gummy. If mealy when baked, they 
are satisfactory. Baked sweet potatoes are equally as 
digestible as Irish potatoes. 

The food value of most other vegetables lies chiefly 
in their salts, especially iron, which makes the coloring 
matter, and in this form it is most easily assimi- 
Vegetable \ ate & m Doctors Courtney and Fales have demon- 
strated by elaborate experiments that half of these 



Feeding in Second Year 65 

mineral salts are lost if vegetables are cooked in water. 
The proper way to cook a vegetable to get the full min- 
eral salt value is to steam it over, but not in, water. This 
teaches that while we cannot give babies vegetables in 
the summer, we can get half their salts value with no 
risk, by giving their extracts in the form of strained 
vegetable soup, made with a chicken, beef, or mutton 
base. Rice or barley may be added to this soup. The 
food value of clear broth is surprisingly small, and it 
does not in any way take the place of milk; even the 
strained soup must be given only once a day, as it deprives 
the baby of the much more nourishing milk. Vegetables 
may be given in winter in the second year. 

Butter may be used on bread or cereals. Sometimes 
babies are able to take it even when in their early months 

they were unable to take milk without the removal 
Butter of some of the cream. The quantity given must be 

dependent upon the bowel condition. An excess 
will cause diarrhoea. 

Keep away from sweets as long as possible. When 
starch in the form of bread, cereal, and potatoes is used, 

there is no real need for sweets, and sugar should 
Sweets be gradually omitted in milk mixtures. Babies 

have a natural tendency to overindulge, and the 
longer they are kept in ignorance of the taste, the better. 
At any rate, withhold them until the third year. 

In adjusting the diet, remember always that every new 
thing is an experiment, to be tried out singly; second, 
Starting tnat ** * s intended for a well child, and the mo- 
a New ment he is sick, stop everything, milk included; 

Diet give only water or barley water, until you have 

further advice. The child is unlike the adult in this 
respect: acute illness, intestinal or otherwise, stops diges- 
tion, and all foods given in a disordered state tend to fer- 
—5— 



66 Care and Feeding of Southern Babies 

ment rather than digest. You should not guess at the 
article causing the illness, discontinue it, and proceed as 
usual, but stop everything and allow the digestive appa- 
ratus to readjust itself, and then cautiously proceed on 
the diet list. 

When milk is mentioned in the subsequent lists, it 

means six or eight ounces of the milk mixture which has 

been previously successfully taken. If it is taken 

Lists readily give it after the solids; if the baby will 

not take it then, give at least six ounces first, then 

the solids. 

If any article of food appears especially distasteful, 
do not force it; let the baby rest and try the food again 
after a few days. In this way the baby is gradually 
trained to take almost any food. In these lists, five meals 
a day are given. They can easily be adjusted to four or 
even to three, to suit the individual child. 

Summer Diet 

From Twelve to Eighteen Months 

7 o'clock — Milk; one coddled egg, or two tablespoons 
of steak juice; one piece of toasted bread and butter. 

10 o'clock — Milk; one toasted cracker, one slice of 
broiled bacon, powdered. 

1 o'clock — Milk or eight ounces of strained soup; two 
tablespoons of rice; one piece of toasted bread, or corn- 
bread and fruit juice. (See page 55.) 

4 o'clock — Milk; one piece zwiebach. 

7 o'clock — Milk; two tablespoons cooked cereal, salted, 
not sweetened. 

From Eighteen to Twenty-four Months 
7 o'clock — Milk; coddled egg or one slice of broiled 
bacon, powdered; two tablespoons of cereal, salted; 
bread and butter. 



Feeding in Second Year 67 

10 o'clock — Milk or fruit juice and zwiebach. 

1 o'clock — Milk or eight ounces strained soup ; scraped 
steak pate as large as a tablespoon; one tablespoon of 
rice; one slice of toasted bread or cornbread and butter. 

4 o'clock — Milk and a toasted cracker. 

7 o'clock — Milk; three tablespoons cereal, salted; 
bread and butter. 

Winter Diet 

From Twelve to Eighteen Months 

7 o'clock — Milk; coddled egg or breakfast bacon; 
toasted bread and butter. 

10 o'clock — Milk and one piece of zwiebach. 

1 o'clock — Milk or eight ounces strained soup; pate 
of scraped steak; one tablespoon of carrots or spinach, 
pressed through a colander, or a small potato, baked; 
cornbread and fruit juice. 

4 o'clock — Milk and one pdece of zwiebach. 

7 o'clock — Milk and two tablespoons of cooked cereal, 
salted. 

From Eighteen to Twenty-four Months 

The same as for the summer diets for the correspond- 
ing age, except for a more extended list of vegetables at 
midday. Vegetables should be pushed through a colan- 
der if necessary, and always give one green and one dry 
vegetable. For the green, select either spinach, aspara- 
gus, turnip greens, squash, carrots, boiled onions, baked 
apple with little or no sugar, or apple sauce; and for the 
dry vegetable, Irish or sweet potato baked, dry beans or 
peas pushed through a colander, rice, grits, hominy, and 
macaroni or spaghetti cooked in the family dish with 
cheese — but leave the cheese off of the part served the 
baby. 

It may be repeated that these are simply suggestions 



68 Care and Feeding of Southern Babies 

and may be varied to suit the convenience; also that when 
the appetite does not seem to justify the frequency, four 
meals or even three meals may be adjusted from this. 

General Suggestions 

When the appetite fails, there is no reason to change 
the food or give tonics; normal babies do not tire of good 
food; only adults object to sameness. It is usual- 
Failing jy j ue tQ over f ee( ling. Restrict him to liquid diet — 
milk, strained broth, and orange juice — for a day 
or so and rest the digestion. Do not try to correct it by 
changing to other, probably more indigestible foods. If 
they won't eat what is good for them, do not give them 
what is bad for them just to tempt the appetite. 

Feeding in Third Year 

Three meals daily at your regular meal times should 
be sufficient, but most children demand something be- 
tween meals. This means a regular (and let it be 
N f Ui Meal regular) lunch, between breakfast and dinner and 
dinner and supper, which reverts to the old five- 
meal system, or the three-hour schedule begun at birth. 
It may be too much for some, but it is hard to satisfy the 
majority without it. These lunches should be at least 
part liquid, say a glass of milk and a cracker, or lemon- 
ade and zwiebach, or buttermilk and toast. If the lunch 
seems to impair the appetite for the next meal, make it 
purely liquid, and if still not hungry at meal time, omit 
it altogether. 

Milk should be continued throughout the year; in 

fact, the longer it is taken, the better. The taste for but- 

Milk After termilk is acquired, but is a very healthy one and 

Second worth cultivating. If for any reason milk must 

Year k e discontinued, it must be seen that the baby gets 



Feeding in Third Year 69 

plenty of water to make up fluid requirements, and this 
is often difficult. 

If sweets have been kept from him to the end of the 

second year, one should be satisfied, though the longer 

they are forbidden, the better. At this time it is 

Sweets saner and safer to compromise. Sweets are chiefly 

harmful because indiscriminately given. Even if 

you do not give them yourself, some well-meaning but 

ignorant friend will slip him a piece of candy between 

meals, and the habit is soon established. Taken at this 

time the candy ferments and produces a full feeling and 

he has no appetite for the next meal. It makes his mouth 

over-acid, and promotes decay of the teeth. Sweet drinks 

are just as pernicious as candy. 

To properly meet the desire for sweets, make it a 

rule in the third year to begin giving a simple dessert, 

such as gelatine, boiled custard, rice, bread or 

Desserts tapioca pudding, fruit jelly, or a small cooky after 

his midday meal, as a reward for taking a good 

meal, not in place of it. If he has to have candy, give it 

then and then only. He is so full he will not take much. 

Ice cream is only as good as the milk that it is made 

from. One should know its origin before using it for 

young children, and it should be given only after a meal. 

Another common defect in the third year is the lack 

of chewing. A baby should be taught to chew. Give 

him hard food that needs chewing, but do not rely 

Chewing on his chewing. See that food is ground or pushed 

through a colander. Do not let him swallow 

lumps of food. 

Fruits or vegetables with husks or seed are not per- 
missible until five years of age or later. Berries are espe- 
cially dangerous. The longer he is taught to regard 
berries as ornamental, not edible, the better off he is. 



70 Care and Feeding of Southern Babies 

The feeding after the second year may be summed up 
under the four rules: 

1. Regular meals, whether three or five a day. 

2. Sweets only after a good meal as a reward for eat- 
ing a good meal, and not in place of it. This applies to 
desserts, syrup, and preserves as well as candy, ice cream, 
etc. 

3. See that everything is finely cut or chopped, but 
teach him to chew. 

4. No food with a husk or seed should be given. 

It is best not to let children eat with adults. They can- 
not help seeing and craving indigestible things. Beware 
of giving tastes of food. It only creates new desires that 
make life harder. 

Sample Diet for Third Year 

7 o'clock — Milk, which may be flavored with cocoa or 
postum; bacon or egg (may now give an egg prepared 
any way except fried) ; a saucer of cereals, salted; bread 
and butter. 

10 o'clock — Fruit juice; zwiebach. 

1 o'clock — Milk or soup; ground or scraped beef, 
chicken or mutton; one green and one dry vegetable; 
cornbread; rice pudding, without raisins. 

4 o'clock — Milk and cracker. 

7 o'clock — Milk; cereal, spoon bread (see recipe) ; 
bread and butter. 

Canned fruits and vegetables should be avoided if pos- 
sible. There is always a slight element of danger in 
them — much less now than formerly. This is true 

Canned £ a( Jults, but food poisonings are much 

Vegetables . . ' .,, £ - & . 

more serious in children. Belore using, canned 

stuff should be brought to the boiling point to sterilize. 



Care of Mouth and Teeth 71 

The Care of the Mouth and Teeth 

While the subject of the mouth and teeth may appear 
out of place in the chapter on feeding, yet, on account 
of the great importance of the proper diet in the forma- 
tion of healthy teeth, it is deemed appropriate to discuss 
the matter here. 

As before mentioned, it is not necessary or advisable 

to regularly wash a baby's mouth before teeth appear. 

See that nothing dirty is put into it, then there is 

rlf^ss no nee ^ to wasn i^ anc * even narm is done by 

abrading the tender mucous membrane. As soon 
as solid food is given, wash down the crumbs, etc., with a 
little water after a meal and wipe his teeth with cotton 
or a soft cloth. When he has sixteen teeth, use a soft 
brush regularly. Cleanliness is preferred to antiseptics. 
Great care should be taken with the temporary teeth, and 
should decay develop, attend to it at once. 

The growth of strong teeth depends upon giving a baby 
a balanced diet. Condensed-milk-fed babies usually have 
Effect of chalky or soft teeth, which decay readily. Illness 
Diet on r poor nourishment causes defective formation of 
the Teeth ^ e tee jj, at tK a t period. Too much and indis- 
criminate sweets, by causing over-acidity of the mouth, 
tend to produce early dental decay. 

If the second teeth seem to come in irregularly or 
crowded, suspect the presence of adenoids. 

Since a large percentage of rheumatism, heart disease, 
and kidney infections have been traced to septic mouth 
conditions, one should be more careful in tooth preserva- 
tion. Strong, healthy teeth depend upon (1) a balanced 
ration in infancy; (2) a healthy, well dieted childhood, 
with proper exercise in chewing; (3) cleanliness of the 
mouth, with early correction of defects. It is rare that 



72 Care and Feeding of Southern Babies 

the permanent teeth are strong, with the temporary set 
decaying and abscessed. The only one of these three 
suggestions feasible in after life to improve bad teeth is 
cleanliness (unfortunately we cannot turn the tide of 
time backward), hence it is so strenuously urged, though 
in the prevention of bad teeth it is the least important of 
the three. 

If a tooth is dead and abscessed, as shown by repeated 
gum boils, it should be extracted at once, regardless of 
the fact that it may cause irregular position of the per- 
manent teeth. 



CHAPTER IV. 



THE TRAVELING BABY 

The necessity for traveling with a baby is unfortunate. 
If on a long trip, cows' milk is unsafe, unless boiled for 
fifteen minutes before starting and kept constantly on 
ice, necessitating a refrigerator. Arrangements must be 
made in advance for the delivery of suitable milk for 
the next day's feeding. Hotel and dining car milk is 
not safe even for older children. These necessary pre- 
cautions are troublesome, and sometimes impossible. 

There is less harm than is usually supposed in chang- 
ing cows' milk; the only difference in the average herd 
Milk fop milk in various sections is that one may be richer 
Use While than the other. To obviate this possible objection, 
Traveling it is safer to remove some of the cream from the 
new supply for a few days. This weakened food will 
probably be better suited to the baby tired from the trip 
and excited by his new surroundings. 

When traveling, it is safer and simpler to change to 
dry milk which requires no cooking, nor refrigeration, 
and can safely be used after arrival until satisfactory 
arrangements can be made for obtaining good cows' milk. 
Two or three days before starting, try several feedings 
of the dry milk to get him accustomed to it. 

If habitually changing location, the mother is rarely 
able to retain a sufficient supply of good breast milk, and 
early resorts to mixed feeding, probably full artificial 
feeding. Good cows' milk is difficult to obtain and neces- 
sitates so much equipment in preparation and preserva- 



74 Care and Feeding of Southern Babies 

tion that it is not practical. It is better to use dry milk, 
now accessible in all cities. One level tablespoon, 
mixed with one ounce of boiled water, makes the equiva- 
lent of one ounce of cows' milk, from which some fat, 
not all, has been removed. Use this on the trip, just the 
same strength as recommended for cows' milk; of course, 
each bottle must be made up immediately before feed- 
ing. When dry foods are mixed with water, they become 
as perishable as cows' milk, and require icing. Under 
three months, use one-half as many leveled off table- 
spoons as ounces in the quantity of feeding; from three 
to six months, two-thirds as many tablespoons; and from 
six to eight months, three-fourths as many; while after 
eight months, use one level tablespoon to each ounce of 
water. This makes one-half-, two-thirds-, three-fourths-, 
or full-strength milk. There is no necessity for adding 
sugar, though if the baby is constipated or the weekly 
gain is insufficient, it may be cautiously given, according 
to the proportions recommended in cows' milk feeding. 
(See page 49.) 

When temporarily settled for several days, and cows' 
milk is dependable, one ounce of boiled milk may be 
added to each feeding and one tablespoon of dry milk 
withdrawn. The second day, use two ounces of milk and 
two tablespoons less of dry milk, and so on until the 
dry milk is replaced by cows' milk; then put him back 
on dry milk when he has to travel again. 

Be careful about the water supply. Boil enough to 
last until you are settled again. Special attention must 
Water be gi yen to cleansing bottles and nipples. Keep 

While the nipples in a flyproof receptacle. Always have 

Traveling an extra supply. A small heater using solidified 
alcohol is a great convenience. Thermos bottles are dif- 
ficult to cleanse and must not be used to keep milk or 



Traveling Baby 75 

prepared milk foods. They are convenient, however, for 
hot water. 

Young children may be taken suddenly ill while on 

the trip. The first direction in any illness is to stop milk 

and feed on barley water. Now this is difficult to 

Sudden III- p re p are w hile traveling. Cracker tea is a good 

substitute. (See recipe.) Always carry toasted 

crackers or bread with you for this emergency. 

Traveling With Older Children 

Do not trust station or dining-car milk until at least 
five years of age. Use dry milk as suggested for babies. 
Other When other foods than milk are given, as much 

Foods as possible should be taken from home. Fresh 

than Milk e gg S are easily carried and cooked on an alcohol 
stove. Broiled breakfast bacon may be reheated. Zwie- 
bach or toasted graham crackers with his own milk over 
it make a good cereal, much better than can be ordered 
from a dining car. Shredded wheat biscuit and corn- 
flakes are permissible for older children. Two-minute 
oatmeal (previously cooked three hours at the factory) 
is reliable. These, with baked potato, baked apple, pro- 
curable at hotels, etc., and fruit juices will suffice for 
quite a long journey. 

Do not expose a baby to coughing and sneezing fellow- 
passengers. Avoid drafts and overheated, close cars 
or rooms. Dress him to suit the immediate temperature, 
but be prepared for any change. See that he gets as 
much undisturbed sleep as possible. For convenience, 
when traveling, rubber napkins or breeches are permis- 
sible, though not under any other circumstances. They 
keep the urine in close contact with the skin, make him 
too hot, and promote chafing. Be especially careful to 
prevent mosquito bites. 



CHAPTER V. 



COMMON DISORDERS USUALLY CAUSED 
BY IMPROPER FOOD 

Chronic Vomiting 

This may be due to many causes, the determination of 
which often requires the combined observation of both 
Chronic mother and physician for many days. We will 
Vomiting mention some of them: 

1. Too tight clothing or bands. 

2. Too rapid feeding and nursing. 

3. Nursing or feeding too much. 

4. Nursing or feeding too often. 

5. Disturbing too soon after his feeding. 

6. Constipation with flatulency. 

7. Too much fat in the food. (Try skimmed milk and 
add lime water, 25 per cent of the quantity of each feed- 
ing.) 

8. Too much sugar. (Remove all the sugar and sweet- 
en with saccharine, if necessary. This is a frequent cause 
of vomiting if using patent foods.) 

9. Too much proteid. (Boil the milk and further 
dilute it.) 

10. Acute infections are frequently ushered in by 
vomiting. 

11. Malformations of the digestive tract. 

12. The gas bubble. All babies swallow air to some 
extent; and in others, gas develops as a product of fer- 
mentation in the stomach if improper food is given. The 
air or gas accumulates, and as soon as it gets warm it 



Constipation 77 

expands, and up it comes, pushing the food before it. If 
food is fermenting, correct it; if he has simply swallowed 
air, just after feeding lay the baby on his right side, 
with head a little high. The bubble of air then comes up 
to the oesophageal, or swallow, end of the stomach, and 
sooner or later it is expelled by belching without losing 
his food. 

Constipation 

During the first year, a baby should have one to four 
stools a day; one is enough, four not too many. At six 
weeks, training should be begun by holding him 
Training out on the lap and touching or inserting into the 
rectum a small glass rod, such as a thermometer, 
or a trimmed piece of soap, or a syringe tip. At the 
same time, touch a small chamber to the buttocks. He 
will be taught to strain and have an action. This is a 
great advantage in watching the stools, and a saving in 
the laundry bill. This should be done regularly, prefer- 
ably before his morning bath and at bedtime. After a 
week, it will only be necessary to touch the buttocks with 
the chamber to produce the straining. 

When old enough to sit up, use the nursery chair, 
taking care to reserve its significance for this special 
occasion, and for a limited time, not over ten min- 
Cha? ePy utes; never allow it to be used simply as a seat 
or for punishment, as is often done. 
If he is gaining, and is sleeping well and happy, con- 
stipation is insignificant, though it worries the mother 
Constipa- immensely. It may be due to an inactive lower 
tion in bowel (he does not understand how to control it) 

Breast-fed or to too complete digestion of milk, not enough 
residue; or to starvation, though this is associated 
with a failure to gain. Possibly rectal diseases or mal- 
formation may explain it. 



78 Care and Feeding of Southern Babies 

Training should be begun at once, no matter how dis- 
couraging. It is a good life habit to establish. Precede 
the training by a gentle rotary massage for five 
Treatment minutes over the abdomen with the finger tips, or 
with a billiard ball, following the course of the 
large bowel; that is, beginning at the lower right cor- 
ner and rolling around over the navel from right to left. 
Do not massage too soon after eating. Purgatives (that 
is, strong purgatives, not laxatives) should never be used 
for simple constipation. Their cleansing is so thorough 
that it intensifies, never cures. 

Do not attempt to correct constipation with food in 
the summer time. It is dangerous. If you give too much, 
you may start an uncontrollable diarrhoea. Drugs are 
safer. If too much magnesia is given, a few drops of 
paregoric will correct the results and no harm is done. 
Too much butter, orange juice, or scraped apple may 
cause an uncontrollable diarrhoea which paregoric only 
aggravates. 

The following measures are recommended for the con- 
trol of constipation: 

1. Strained orange juice is often quite effective. One 
tablespoon half way between meals and increased until 

Dietetic vou § et effects; as much as four ounces may be 
Treatment given. It may be given as early as three months, 
of Consti- It is always harmless, and a possible colic is the 
pation on jy chance G f bad results. Even if not effective 

it is an addition to the food. 

2. One-half to two teaspoons of good butter once or 
twice a day may be given before nursing. This may be 
begun at four months. Butter is more effective and safer 
than cream. It is readily taken; does not require melt- 
ing or sweetening. 

3. Scraped apple, one to three teaspoons daily, may 






Constipation 79 

be given in winter to babies over eight months. It is 
quite successful, but is especially dangerous in summer. 

Among the drugs, milk of magnesia is least harmful 
and gives the best results. Unfortunately, its effect varies 
with each child, so begin with one-fourth of a 
Drugs teaspoon every six hours until it acts, increas- 

ing or decreasing the dose as necessary. It may 
be given in milk. 

Mineral oil, sold as liquid albolene and nujol, and 
under many other proprietary names, is effective — one 
teaspoonful night and morning, increasing or decreasing 
according to the indications. Both of these remedies are 
beneficial when stools are hard and dry, and they have 
little tendency to cause a habit. 

If the day has passed without a satisfactory stool, give 
an enema at bedtime and a laxative. Enemas, especially 
small low enemas, are probably harmless, but their relief 
is only temporary. If the case resists this treatment, ap- 
ply to your physician. 

In addition to the measures suggested for breast-fed 
babies, cereal water instead of plain water may be used 
Constipa- m making milk mixtures for artificially-fed babies. 
tion in Ar- Oatmeal water is most laxative. Changing the 
tificially sugar from cane to malt or milk sugar, or vice 
Fed aoies versa> ma y nave the desired effect. Malt sugar, in 
my opinion, is most laxative, though others think differ- 
ently. Increasing the amount of sugar may correct it, 
though it must be done cautiously. Making the milk 
richer by using cream or top milk instead of whole milk 
is dangerous. Too much cream may aggravate the con- 
dition, causing hard, white stools. 

Constipation in older children should be treated as in 
adults, but they are more susceptible to the training 



80 Care and Feeding of Southern Babies 

process, which should be begun early, but may be begun 
at any age. 

Diarrhoea 

Summer diarrhoea, dysentery, colitis, summer com- 
plaint — different names for the same disease — represent 
a condition of thin stools more frequent than normal, 
with blood and mucus. It is not, strictly speaking, a dis- 
ease, merely a symptom, being nature's effort to rid the 
intestine of some irritant. It is the most fatal of all the 
infantile conditions that confront us. The predisposing 
causes are: Age, season, hygiene, teething, food. 

Age — It is more frequent under two years. In older 
children it is quite common, but not usually serious. 

Season — Diarrhoeas begin in June and are preva- 
Causes of lent until heavy frost; worse in the early summer 
Diarrhoea ^^ i a j- er> This j s probably due to the depress- 
ing effects of the first heat and also to the changes in the 
food. 

It is impossible to escape the danger of summer diar- 
rhoea entirely. The best preventive is to take the baby to 
the New England coast or to Northern Michigan. One 
must go early and stay late. The low mountain resorts 
east of the Mississippi offer a poor means for the escape 
from this scourge, though, of course, they are much bet- 
ter than crowded cities or even adjacent low country. 

Hygiene — Fortunately in the South, hygienic errors 
play but little part in the causation of diarrhoea. Our 
babies have plenty of fresh air and usually good sur- 
roundings. There is little of the tenement element to 
contend with. The grossest errors seen are too much 
clothing and overheated nurseries in the winter, which 
cause anaemia and lack of resistance. Babies with the 
best surroundings are often kept in a nursery with a tern- 



DlARRHCEA 81 

perature of 80°, with no fresh air, and loaded down with 
flannel. If the same heat were present in the summer, 
the mother would be at the seashore. 

Teething — This by some modern writers is forbidden a 
place in the causation of diarrhoea, and possibly correctly 
so. During an acute teething period, baby is restless, 
fretful, sleeps poorly, is perhaps slightly feverish (never 
more than 100°), and certainly there is a diminished 
power of digestion. Foods should be weakened during 
an acute teething period. It is the undigested food that 
exaggerates the situation. Teething means not illness 
but merely a period of predisposition to it, and must 
never be accepted as the explanation of diarrhoea, as is 
so frequently done. On the other hand, should diarrhoea 
develop during a teething period, the most strenuous 
efforts should be made to correct it at once. 

Food — Food is the great predisposing cause. Breast- 
fed babies rarely have diarrhoea except as referred to on 
page 31, and this is insignificant. The mortality of the 
few that do develop it is strikingly low. Human milk 
seems to immunize against it; even a small amount gen- 
erally protects. 

Good milk is essential in the prevention of diarrhoea. 
In the presence of one or more predisposing causes, age, 
season, faulty hygiene, teething — always boil the milk to 
be sure of its sterility, also in a measure to get rid of the 
peculiar element contributed by weedy pastures in early 
summer. 

During the winter, baby should be kept thoroughly 
nourished. Even though apparently well, see that he is 
getting a balanced ration. If fed on patent foods with 
an excess of sugar, he may be rolling in fat but show 
little resistance to diarrhoeal infections when summer 
comes. 

—6— 



82 Care and Feeding of Southern Babies 

Undigested food of any sort is a predisposing cause. 
The stools should be carefully watched and the appear- 
ance of undigested food regarded as a danger signal. 
Do not give tastes of forbidden foods. Even one straw- 
berry may start a fatal diarrhoea. Do not try to force a 
baby to gain in the summer by giving overrich milk; keep 
him well and be satisfied. 

The exciting cause is a germ or germs, the exact na- 
ture of which is not well defined, but all precautions 
should be taken to avoid infection. In the country 
Exciting open privies should be screened to prevent access 
Cause ky flj es Water should be boiled; soiled napkins 

must be kept in flyproof containers, and food and feed- 
ing utensils carefully protected from flies. 

In order to prevent diarrhoea, observe the following 
rules: 

1. Human milk is the only perfectly safe food. Make 
the best use of every available drop. 

2. Patent foods are deficient in fats and freshness, 
and though babies may appear to thrive and fatten on 
them, they lack resistance and fall early victims to diar- 
rhceal infections. 

3. Feed babies only the best and freshest milk avail- 
able. 

4. Boiling the milk makes it safer and more digestible. 
The only defects are the constipating and scorbutic ten- 
dencies, which are easily corrected. 

5. Babies need less food in the summer. In the be- 
ginning of hot weather, weaken their milk mixture and 
give more water. 

6. The appearance of partially digested food in the 
stools, such as milk curds, is a danger signal not to be 
neglected. Such masses scrape off the protecting intes- 
tinal lining and favor infection. 



DlARRHCEA 83 

7. Do not attempt to correct constipation in young 
children in the summer by laxative foods. You are liable 
to overdo it and start an uncontrollable diarrhoea. Pur- 
gatives are safer. 

8. Fruits and vegetables should not be used in the 
summer with babies under two years of age, and only 
with the greatest care with older ones. 

9. At the onset of any acute illness, digestive action 
stops or is greatly impaired, and food does not nourish 
but becomes a culture medium for the invading germs; 
hence, whenever the baby is the least bit sick, stop all 
foods, especially milk, and give only water, but plenty 
of it, until the exact nature and extent of the pathology 
is determined. 

10. Treat all bowel disturbances as serious. The nat- 
ural tendency is from bad to worse. Begin early and 
prevent terrible cases. 

Diarrhoea is too serious a disease to attempt to outline 

the treatment. Get the best physician available. Do not 

be satisfied with giving a purgative. Oil and calo- 

Treatment mel simply clean out the alimentary canal, but 

remember that digestion stops, or is weakened, 

with an onset of the infection; and unless you stop food, 

the purgative does no good, rather harm. Castor oil is 

not healing; only cleansing. 



CHAPTER VI. 



CARE OF THE SICK BABY 
Nursing 

While not so attractive a subject as that of keeping 
the baby well, we should know what to do with him in 
adversity. Prevention is far more effective than cure, 
and every effort should be made to keep the baby thor- 
oughly built up to resist disease. 

Do not give any article of food simply because the 
child wants it or because it will do no harm. Be sure 
that everything he eats will help build him up and do 
good. 

Choose a well-lighted, well-ventilated, quiet room. 

Keep the temperature not over seventy. Nothing is so 

depressing to a child as an overheated room. If 

Sick Room he is cold, apply hot water bottles, or better still, 

hot blankets. Be careful not to burn him, which 

is easily done. Allow no company. Illnesses often prove 

contagious when not so suspected at first. Especially 

keep other children away. In the summer it is often 

quite restful to take him out under the shade of a tree. 

Always nurse the baby on the bed; never in the lap. 

The bed supports him better, is more comfortable, and 

allows freer respiration and better air, while nursing in 

the lap requires so much more care and attention on the 

part of the nurse. 

Once daily a sick baby should have a cleansing bath, 

a quick one, with the least possible disturbance. A 

Bathing sponge bath will answer, though sometimes a rapid 

the Sick tub bath is less depressing. If the circulation is 

Baby bad in the morning, as shown by cold feet and 



Nursing the Sick Baby 85 

hands, the bath should be delayed until later in the day, 
when he has warmed up. 

The mother should be able to describe to the doctor 

the child's condition since the beginning of the illness, 

his sleep, his manner of playing, his appetite, his 

Illness^ ° f P am - Never ask a child specifically what hurts 

him. A nervous child naturally attributes pain to 

any point suggested. Watch him, or press on him, and 

tell by his actions and expressions where the pain is. It 

is very necessary to examine the stools. Always save 

them for the doctor; he should see every one of them, 

no matter how many there may be. It is a good plan to 

place a piece of cloth, about eight inches square, in the 

napkin, so as to catch practically all of the stool; put 

this in a flyproof box for the doctor's inspection, while 

the napkin is promptly sent to the laundry. 

The doctor should see the baby without clothing. 
When expecting the doctor, take off the clothes and wrap 
the baby in a blanket, and so save the nervousness caused 
by the trying ordeal of undressing in the presence of a 
stranger. 

Indigestion, to a certain extent, complicates every ill- 
ness, especially in the summer, when digestive disorders 
are prevalent. When illness begins, digestion stops 
I ill UP " anc ^ ^ 00( ^ §i ven f eeQl s the germs of disease rather 
than nourishes the baby. The most important 
direction in the beginning of an illness is to lighten the 
diet. Under two years, allow no milk and no solid food; 
even breast milk should not be given until the doctor 
so advises. Until further orders, give plain water, 
strained barley water, toast water, or cracker tea. If 
over two years old, strained broth, or boiled milk diluted 
with equal parts of water may be given. 

In stopping milk, the chief water supply of young 



86 Care and Feeding of Southern Babies 

babies is withdrawn, yet in illness, with high tempera- 
ture, and increased loss of water through bowel 
Water actions, vomiting, etc., a baby needs water more 

than in health. Do not wait for him to ask for 

water, but offer it every few minutes. 

Indiscriminate use of drugs does more harm than good. 
Be sure that there is an indication for every dose of 
medicine given a baby. It is far preferable to 
Drugs omit all drugs until they are ordered. Paregoric 

and fever mixtures will mask symptoms and de- 
ceive the physician. While purgatives are probably more 
useful, they do no good except to cleanse the intestine of 
fermenting food. It is useless to give them unless food 
is withheld at the same time. Purgatives in the presence 
of abdominal pain are especially dangerous and should 
never be used. Until the doctor comes, it is best to con- 
tent yourself with giving a tepid bath, if necessary to 
relieve fever and restlessness, and an enema to empty the 
lower bowel. 

Do not trust your memory; write the doctor's orders 
and follow them accurately. 

Be positive in giving medicines. Do not coax a child to 
take it. Do not deceive. If it is disagreeable, do not 
Adminls- sav ** * s good. Do not make a face at the medi- 
tering cine yourself for the child. Do not mix drugs with 

Medicines food. An exception to this rule is milk of mag- 
nesia, which may be given in milk without altering the 
taste. Babies dislike highly flavored mixtures. A simple 
bitter is more readily taken than highly seasoned stuff. 
In giving a powder, mix into a paste with sugar and 
water. Castor oil should be warmed to make it flow 
freely and not stick to the mouth. The various scented 
castor oils are effective and easily taken, especially by 



Forced Feeding 87 

older children. If necessary to force the taking of oil, 
do the same as you do in forcing the child to take food. 

Teach the child to consider the doctor his best friend. 
Never threaten him with the doctor. Do not tell him 
that he will have to be cut open if he eats imprudently, 
or promise an amputation of the thumb if he doesn't 
stop sucking it. Do not associate the doctor with castor 
oil. 

Children should be accustomed to a routine daily 
throat examination when well, so that when the doctor 
is obliged to see the throat, it will not require such a 
struggle. 

Forced Feeding 

While digested milk is the best possible food, if undi- 
gested it is the most dangerous. Milk should be discon- 
tinued at the onset of any acute disease. Unfortunately, 
when it is stopped the chief water supply ceases. A 
year-old baby takes over a quart of milk daily. If he is 
sick, it is difficult to get him, to take one glass, or eight 
ounces, of water. He may take it frequently, but almost 
in inappreciable quantities; yet a sick baby needs water 
more than ever for the following reasons: 

1. To replace the extra loss of fluids from the body, 
due to vomiting, diarrhoea and the febrile processes. 

2. To make possible proper secretions and excretions 
and so to promote digestion and elimination of the 
poison. 

3. While in most diseases we do not know the antidote 
for the toxine producing them, we can relieve symptoms 
by diluting the poison and lessen its effects by giving 
water and plenty of it. 

Hence, when ill, an ordinary child a year old should 
get at least a quart of fluid every twenty-four hours, and 



88 



Care and Feeding of Southern Babies 



better still, two quarts; if under six months, one and one- 
half pints will answer; and under two months, one pint. 
Do not wait for a sick baby to ask for water, but offer it 
every few minutes. Try to get the amount down in the 
daytime, so that he will get rest at night. It is by far 
the most important thing we can do for the patient. He 
can live days without food, but rapidly wilts without 
water. Do not regard the interval nor the quantity given, 




DIAGRAM ILLUSTRATING THE METHOD OF 

FORCED FEEDING 

The spoon introduced far enough to prevent closure of the teeth and 

also to hold the tongue down. 



Forced Feeding 89 

but keep account of the entire twenty-four-hour amount. 
If the quantity he takes willingly is not sufficient, it must 
be forced. 

It is not unusual to see a diarrhoeal case ill several days 
with probably an average daily intake of four or five 
ounces of fluid, the skin dry, paper-like, mouth parched, 
kidneys sluggish, head thrown back, tossing on pillow, 
moaning, but too dry for tears. Such is the picture of a 
sick baby deprived of water — the tissues craving it, but 
the appetite repelling it. 

Formerly fluids were forced by pouring them down 
through a small stomach tube, necessitating the presence 
of a physician or a specially trained nurse. The follow- 
ing method has been successfully used by the author for 
two years, with no bad results. It can be done by the 
family, best by three persons, though two may succeed. 
One assistant holds the hands and feet, the other the head 
and the spoon in the mouth. Place the bowl of an ordi- 
nary teaspoon in the mouth over the tongue, so that the 
upper third of the bowl projects beyond the lips, and 
into this projecting part pour the liquid with another 
spoon or a bottle. 

Eight ounces may easily be given in fifteen minutes. 
There is little lost, and not much tendency to vomit. It 
is best to give small quantities frequently, as the process 
is easy, rather than risk over-distension of the stomach. 
There is no danger of strangulation if only liquids are 
used, though it may produce a slight cough. 

The many advantages over the stomach tube are too 
obvious to mention. It is also the best way to give castor 
oil to a resisting child. I have never heard of the use of 
this method before, though it is so simple it seems impos- 
sible that it should be new. 

If a child passes twenty-four hours without getting his 



90 Care and Feeding of Southern Babies 

full fluid allowance, see that he gets it during the next 
day; by persuasion if possible, by force if necessary. 
Usually, but not always, after getting the full amount 
for one or two days, normal secretions are established, 
appetite returns, and fluid is taken willingly. 

Baths, Packs, and Enemas 

Strip the baby, lay him on a soft quilt, and sponge 

him with tepid water. The reduction of heat depends 

Warm upon the evaporation of the dampness. This is 

Sponge soothing, but not very effective in lowering the 

Bath fever. 

Full baths may be given in an ordinary tub, but it is 
hard and uncomfortable. A puddle bath is much more 
Puddle satisfactory to both patient and nurse. Use a rub- 

Bath for ber sheet at least a foot longer than the child; all 
High around under the edges of this place a rolled sheet, 

ever thus making a tub in bed. Always begin with 

tepid water, about 100°. Keep a wet towel over the 
abdomen, and an ice bag to the head. Gradually reduce 
the temperature of water to 90°. Sick babies, even 
though feverish, do not like cold water. Bathe until the 
fever is reduced to 102° or 101°, using a thermometer in 
the rectum every few minutes. There is less shock to a 
forty-five-minute tempered bath thus given than to a ten- 
minute really cold bath of 70°. Rub dry with consider- 
able friction, and if the feet are cold apply hot-water bot- 
tles. The fever will continue to decrease at least one-half 
hour after finishing the bath. As to the amount of fever 
requiring a bath, 103° is a fair limit, but the beneficial 
results are as much from the soothing effect as from 
reducing the temperature. It is more necessary to give a 
bath to a nervous, twitching, irritable patient with 102° 
than to one resting quietly with 104°, 



Baths, Packs, and Enemas 91 

This is used to reduce temperature and relax. Soak 
a large Turkish towel or blanket in as hot water as can 
be borne, wring out the excess, and quickly wrap 
Hot Pack the child in it, and allow it to remain for ten min- 
utes. Dry rapidly and wrap in a warm blanket 
without stopping to put on the gown. He generally sleeps 
quietly for an hour after this. 
Hot Mus- This is given the same way, except that one 

tard Pack rounded tablespoon of mustard is used in each gal- 
lon of water. 
This is used to relax and also to reduce temperature 
and to stimulate. Put two rounded tablespoons of mus- 
tard in a tub of water (about ten gallons), tem- 
tard Bath perature 105°. Immerse the child up to the neck 
and allow him to remain for five minutes. Have 
a warm blanket with a large towel ready, wrap him up 
with blanket and towel; dry with towel while still 
wrapped, withdraw it, and let him sleep off the relaxing 
effects of his bath rolled in the blanket, without disturb- 
ing him to put on a gown. 

This is indicated in skin diseases, such as prickly heat, 

or eczema, and with babies whose skin soap seems to irri- 

Bran tate * P rocure ordinary wheat bran from a feed 

Bath store, make a cheesecloth bag sufficient to hold a 

large handful of the bran, and put this bran bag in 

the bath water while it is very hot. By the time it is the 

correct bathing temperature, it will be an emulsion. Use 

the bran bag as a wash cloth. It is an effective cleanser 

and does not deprive the skin of its natural oil as soap 

does. Of course, use fresh bran for each bath. 

During the first year, the ear and ulcer syringe of soft 

rubber is sufficient for the ordinary low enema; there are 

two sizes — one and three ounces. The larger is 

Enemas preferable. It is impossible to hurt a child with it. 

Do not get the so-called infant syringe, which has 



92 Care and Feeding of Southern Babies 

a hard rubber tip. Warm water or normal saline solution 
(one-half teaspoon of salt to the pint) is generally used, 
unless other solutions are specified. One to two large 
syringefuls or one to four small ones may be introduced 
at a time. 

The ordinary fountain syringe is better after first year. 
Hold the bag so that the surface of the water in the bag 
is not more than one and one-half feet above the rectum, 
and there need be no thought about the quantity taken. 
This much pressure can do no harm. The rectum fills up 
and overflows. By holding the baby on the right side and 
elevating the hips, a thorough flushing of the lower bowel 
can often be accomplished as well as, or better than, by 
using the rubber catheter, which is sometimes difficult to 
introduce, owing to the peculiar folds of the bowel. 

Use the fountain syringe with No. 10 soft rubber cathe- 
ter, attached. Introduce the catheter well anointed with 
High vaseline, about two inches, holding the bag about 

Rectal one and one-half feet high; allow the water to dis- 

Irrigation tend the lower rectum, then slowly push the 
catheter farther in, which can usually be done readily, 
though sometimes it may double on itself and twist up. 
If this happens, try the method suggested above of rais- 
ing the hips, which is easier and almost as reliable. 



CHAPTER VII. 



EMERGENCIES 

Sudden Vomiting 

Sudden vomiting is always alarming to mothers, but 
it is only nature's method of getting rid of something 
unsuited to the stomach, which, if retained and passed 
through the intestinal tract, might cause serious illness. 
Instead of trying to stop it, vomiting should be encour- 
aged by giving copiously plain water, or better, one level 
teaspoon of cooking soda (sodium bicarbonate) in a 
glass of hot water. When the stomach is thoroughly 
cleansed, the nausea will cease. Give as much soda 
water as possible, three or four glasses will do no harm. 
Crushed ice is soothing. Withhold all foods until the 
child seems normal. Sudden vomiting, especially if ac- 
companied by fever, may be the initial symptom of some 
infectious disease, and, of course, demands the attention 
of a physician. 

Indiscretions in Diet 

When improper food has been taken, such as a bottle 
of sour milk, or indigestible articles pilfered from the 
refrigerator, or green apples from the garbage pail, do 
not think of a dose of oil, but give at once one-half to 
one teaspoon of syrup of ipecac, repeating every half- 
hour until vomiting is produced. If possible, give hot 
water or soda water, to assist in cleansing the stomach. 
This is far better than a purgative, because you get rid 
of the material at once, instead of forcing it down through 
the more easily infected bowel. There is no objection to 



94 Care and Feeding of Southern Babies 

the use of oil afterwards, especially if the indiscretion 
is discovered late, when some of the undigested food has 
passed out of the stomach into the bowel. 

Swallowing Foreign Bodies 

It is natural for a child to put everything into his 
mouth, so nothing small should be used as a plaything 
or left within reach. Toys should have no projecting 
points to break off. It is remarkable how large an object, 
even with sharp points, can be swallowed and success- 
fully passed. The narrowest point of the entire tract is 
at the root of the neck; and if it gets by this into the 
stomach, it is generally passed easily, but slowly. It is 
usually a week, sometimes longer, before it is discovered 
in the stools. 

Unless the foreign body lodges in the throat, there is 
nothing to be done. If an emetic is given, the narrowest 
part of the entire passage is in the swallow, and it may 
lodge there returning. If a purge is given, the hurrying 
through may cause it to catch. Let it alone; have pa- 
tience; it will pass. If there are any sharp projecting 
points, give plenty of starchy foods, such as bread, 
cereals and potatoes, or with younger babies, cereal 
gruels which leave quite a residue after digestion and coat 
the body, at least partially covering the sharp points. 
Babies have successfully manipulated coins, buttons, ordi- 
nary pins, tacks, open safety pins, small dolls, peach 
stones, and a watch chain with a cross-bar. There is no 
danger of poisoning from swallowing a copper cent. The 
X-ray affords great assistance in watching these cases, 
but is not often necessary. 

Abdominal Pain 

This very common ailment was formerly the invariable 
signal for castor oil. The usual cause is intestinal indi- 



Croup 95 

gestion, and oil is correct if you are sure of the diagnosis. 
Not infrequently, however, appendicitis or intestinal ob- 
struction may cause stomach ache. In such cases, castor 
oil or any purgative does irreparable injury, converting 
a simple surgical operation into a very serious one, 
besides losing valuable time. 

First relieve the pain. This is certainly more humane. 
Empty the stomach by giving one-half to one teaspoon 
of syrup of ipecac every half hour until vomiting is pro- 
duced. Apply a plaster made of one part mustard and 
four to eight parts flour to the painful region until the 
skin is red (usually ten to twenty minutes — do not blis- 
ter). Give a high enema, a teaspoon of salt to the 
bag of hot water, holding the bag two feet high. There 
is no fear of giving too much with only this pressure. If 
after these remedies the pain is not relieved, call your 
physician. Do not give a purgative in the presence of 
acute abdominal pain. (For "Colic," see page 32.) 

Croup 

Simple catarrhal croup is a bad cold in the larynx 
which causes, through the inflammation of the vocal 
cords, a hoarseness and a spasmodic contraction of those 
cords, which apparently tends to produce strangulation, 
but never quite accomplishes it; for as soon as the child 
relaxes, he gets a good breath. Catarrhal croup is not 
dangerous, but alarming. It must not be confused with 
membranous croup, a most serious condition, which is 
diphtheria affecting the larynx. 

Simple croup is in a measure hereditary. Children of 
certain families are subject to it. A slight cold with 
them will cause croupy symptoms, which appear at night 
and are usually repeated for three or four succeeding 
nights, while in the day there is no sign of it, except pos- 



96 Care and Feeding of Southern Babies 

sibly a cold or cough. He awakes at 11 p.m. with a 
hoarse barking cough, which becomes more frequent until 
every breath is rasping. The child is excited and this 
increases the spasm. If nothing were done to relieve 
him, he would finally relax, drop into a sleep from ex- 
haustion, only to begin again after a rest; and although 
passing a horrible night, would seem to be as well as 
usual the next day. 

Build up the child so as to prevent colds. Accustom 
him to fresh air night and day, but do not try to harden. 
Reduce the nervous tension by regular bed hours. 
Treatment A morning cold sponge bath may be begun. (Page 
111.) Avoid exposure to infections. If croup is 
anticipated, give a light supper and a laxative. Rub the 
chest and throat thoroughly with camphorated oil. Give a 
hot footbath at bedtime. If cough is severe, with a croupy 
tendency, give, for a three-year-old child, five drops 
syrup of ipecac in a teaspoon of water, hourly. If 
the cough is tight and hoarse, and the child excited and 
nervous, add to each dose ten drops of paregoric. If this 
fails to relieve, give one-half to one teaspoon of syrup 
of ipecac every half hour until he vomits, which relaxes 
him and relieves the muscular spasm which causes the 
croup. 

Inhaling warm, moist air sometimes relieves. This is 
best applied by use of the croup tent, which is made by 
throwing a sheet over his bed, or if on a large bed, by 
raising an umbrella and throwing a sheet over that and 
running the steam under the tent thus made. The steam 
may be generated by an electric heater or a small tea- 
kettle set on top of an inverted electric smoothing iron, 
with a paper pipe made of a rolled magazine to convey it 
underneath the tent. Opening a kettle of boiling water 
under the tent may supply enough heat and moisture. 



Convulsions 97 

The mother may lie down under the tent with the child 
if he is frightened. Ice cloths applied to the throat fre- 
quently relieve croup, but must be used carefully. 

Membranous croup has the same hoarse, barking cough 

and obstructed breathing. It is very serious, but never 

becomes so under twelve hours. It persists day 

Membran- an( j n j gnt usually a little worse at night, but it is 

OUS OrOUD D . . . . • 1 t l r 

progressive in intensity, with little or no lever. 
Croup in the daytime demands medical attention. 

Convulsions 

This most alarming emergency is but a symptom of 
some serious condition, and not a disease in itself. It 
may be due to brain disease, but this is rare in childhood ; 
it may be the initial symptom of some infection, as pneu- 
monia or scarlet fever. A chill in an adult is often 
equivalent to a convulsion in a child, but the common 
cause of convulsions in childhood is some food poisoning. 

There may be forewarnings, such as muscular twitch- 
ing, restlessness, or fever. Suddenly every muscle con- 
tracts, the head is thrown back, eyes are open and 
Symptoms drawn, back bowed, hands gripped, teeth clinched, 
sometimes biting the tongue; breathing is labored 
and slow; the child is totally unconscious. All of these 
symptoms may last from one to thirty minutes, then the 
child lapses into a deep, semi-conscious sleep. 

Of course, the physician is called at once, and it is 
left to him to determine the exact cause of the trouble, 
but the symptoms are so urgent that something 
Treatment must be done before his arrival. The great major- 
ity of convulsions, certainly nearly all of those that 
immediate treatment will relieve, are of digestive origin. 
It is safe to assume this, so direct your efforts first to 
relaxing the spasm, then to cleaning out the alimentary 

—7— 



98 Care and Feeding of Southern Babies 

canal. A warm bath, preferably containing mustard, is 
a time-honored remedy and a good one. It should be 
as hot as can be borne, but not scalding. This takes sev- 
eral gallons of hot water. A hot mustard pack (see page 
91) , requiring only a half gallon of hot water, is quicker 
and just as effective. Even tepid or cold water with 
mustard will do good. While in the bath or pack, give 
the child an enema, preferably of soap water or plain 
water. If he has taken food within the past four hours, 
just as soon as he can swallow give a teaspoon of syrup 
of ipecac, repeating every half hour until vomited. After 
the stomach has been emptied, or at once, if there has 
been no food taken for at least four hours, give one table- 
spoon of castor oil. Nothing but water, and plenty of 
it, should be given by mouth, but even wait for this until 
the castor oil has settled. 

Convulsions are rarely fatal during the attack, though 
always alarming. Their seriousness depends upon the 
cause, which can only be determined by a careful study 
of the case. In some nervous children, apparently insig- 
nificant disorders will produce them. 

Nose Bleeding 

Nose bleeding is rarely serious; often even helpful. It 
usually stops before harm is to be feared. 

Let the child sit up, not lie down, and apply ice cloths 
to face and nose. Plug the nostril with cotton or soft 
cloth and allow the plug to remain at least one hour 
after the bleeding has ceased. Of course, the bleeding 
may continue through the back of the nose and the blood 
swallowed cause subsequent vomiting, but usually it 
stops. If these measures do not succeed, consult your 
physician. 



Earache 99 

Foreign Body in the Nose 

If something becomes lodged in a nostril, stop the 
other nostril and make him blow it out. If this fails and 
the object is plainly seen, try to pull it out with a bent 
hairpin. Do not bruise the parts and cause swelling. If 
not successful after a few careful trials, consult , a 
specialist. 

Foreign Body in the Ear 

Unless this comes out most readily, see a specialist. 
Efforts to remove frequently push it farther in and in- 
crease the pain. 

Earache 

Earache in a baby is difficult to recognize. Look every- 
where else for the cause of pain and if nothing is found, 
suspect the ear. Pressure just in front or behind the 
canal, even when he is asleep, will show tenderness and 
confirm your suspicions. 

Fill the ear with warm glycerine, or irrigate with water 
as hot as can be borne, and apply a hot cloth, or wrap 
the head in a warm shawl. Ear pain may indicate the 
formation of pus in the middle ear. If it continues over 
a few hours, or if accompanied by fever, it requires the 
services of a specialist. Ear infections are practically 
always extensions of diseases from the throat. 

Burns and Scalds 

If severe or extensive, call the doctor at once. Keep 
the parts clean and apply a soothing lotion. Do not 
break the skin. A plaster of sodium bicarbonate and 
water spread on gauze or cheesecloth and applied is 
soothing; or use the following solution: Put one heap- 
ing tablespoon of magnesium sulphate (ordinary salts) 



100 Care and Feeding of Southern Babies 

in a tumbler of water. Wet gauze with it and apply. 
After pain is relieved, use an antiseptic ointment. 

Bruises and Wounds 

Bruises need but little attention if the skin is not 
broken. Ice cloths relieve pain and swelling. As nearly 
as possible keep parts at rest. If the skin is broken, keep 
the parts clean and make one application of tincture of 
iodine to the surface of the wound — not to the skin 
around it. Iodine quickly blisters the skin of a child, so 
use carefully; then apply a sterile gauze dressing. If 
there is bleeding, apply a folded handkerchief or gauze 
pad or cotton, and press on it. Very little pressure will 
stop even severe bleeding. If there is a spouting artery, 
press hard ; if on an extremity, tie a handkerchief around 
the limb about the wound tight enough to stop circula- 
tion, and call a surgeon. 

Crying 

Crying is not always harmful. It distends and helps 
develop the lungs, which is quite beneficial, especially 
in frail babies. It is the only way the baby has to show 
mental or physical distress and the cause should be 
determined. Instead of hunger being your first guess, it 
should be your last. 

Crying may be due to: 

1. Indigestion or colic, when food would only add 
fuel to the fire. 

2. Thirst. Give warm water; it can do no harm. 

3. Uncomfortable clothing, a pin, tight band, or nap- 
kin. The napkin may be soiled. 

4. Cold feet. Apply heat. 

5. He may be too hot or the room too close. 

6. He wants to be taken up. Don't do it except to 
investigate. 



Crying 101 

7. He may want company or a light or rocking. If 
he gets what he wants, he will cry again. Don't start the 
habit. 

8. He may have a lump of feces in the lower bowel. 
If constipated, give an enema. 

9. He may have sore throat or an earache. Examine 
the throat. Press gently in front and behind the opening 
of the ear and see if he flinches. 

10. He may be ill. See if he has fever. Watch his 
posture and expression to locate the pain. 

11. He may be hungry. If he gets a full feeding at 
proper intervals, it cannot be this. 



CHAPTER VIII. 



MINOR AILMENTS 
Birthmarks 

Many babies have birth marks. The most common 
form is a pinkish or bluish splotch between the eyebrows 
or on the nape of the neck about the edge of the hair. 
Unless it is raised above the surface and can be felt as 
well as seen, it will probably disappear in four months, 
only to be slightly visible after that during crying or 
coughing which congests the head. 

A raised dark red mark on any part of the body some- 
times enlarges with wonderful rapidity. As soon as it is 
noticed, cut a piece of paper its exact shape and size, 
mark the date, and watch it. If increasing, the sooner it 
is removed the better; but if stationary, it is preferable 
to wait until the baby is stronger. 

Protruding Ears 

Protruding ears disfigure a baby more than a child or 
an adult, but most mothers want it corrected at once, 
and it is easily done. Be careful in laying him down not 
to fold the ear forward. Paste the ear back with a strip 
of adhesive plaster one-half inch by one inch, or in bad 
cases have it twice as long and let it go entirely across the 
ear. Shave off a little of the hair so that it will stick 
well. The earlier the treatment is begun, the better. 
Usually after a few weeks the tendency to stick out is 
overcome. The rubber stains on the skin from adhesive 
plaster are easily removed by sponging with gasoline 



The Nervous Child 103 

(do not use it near a fire) . A cap of tape is made to hold 
the ears in place, but is more disfiguring and much less 
effective than the plaster. 

The Nervous Child 

Some babies are born nervous; others have it thrust 
upon them. A nervous child cries easily, sleeps lightly, 
digests with difficulty, wears his mother out and 
Nervous- causes early disappearance of breast milk, necessi- 
tating artificial feeding with its attendant woes. 
Finally, by trials and tribulations, he gets through the 
pitfalls of babyhood, becomes an interesting toy for his 
elders, goes to bed late in an excited state of mind, sleeps 
poorly, eats hurriedly, without chewing. His appetite 
becomes capricious. He stops milk, as it is too tasteless. 
He is too occupied to drink enough water. The only time 
he drinks is with meals, which is better than not at all, but 
water is filling, and takes the appetite for stronger food, 
and very frequently it is used to wash down imperfectly 
masticated food. His precocity has won many thought- 
less adult friends who slip him sweets, then appetite fails, 
teeth decay. He becomes wiry, skinny, and often begins 
bed-wetting. 

He is headstrong, spoiled, disobedient, does not recog- 
nize authority, develops an uncontrollable temper. This 
temper, which grows as he does, will become a potential 
evil. 

He goes to school early, is precocious, a favorite with 
his teachers, makes two grades a year, develops a fond- 
ness for books and reads when he should be sleeping or 
having outdoor exercise. 

School hours are not regulated for the physical good 
of the child. He eats breakfast hurriedly, and excitedly, 
rushes to school with food half masticated; relies on his 



104 Care and Feeding of Southern Babies 

school lunch (too often a ham sandwich and candy; milk 
and soup are rarely served except to poor children), 
returns physically and mentally exhausted to a cold din- 
ner, then takes too much supper. How can you blame 
him, as it is the only normal meal? He sleeps restlessly 
as the result. 

How can we expect the best results, physical or men- 
tal, under such circumstances? Do not push, neither 
retard a child. Anything which does not interfere with 
his fresh air, good sleeping and early retiring is permis- 
sible. 

He may survive it all with an uninjured nervous sys- 
tem, but the chances are against him. Usually he be- 
comes a neurotic, taking everything hard; a dyspeptic, 
with a sour disposition; possibly a success, but through 
hard knocks and much unhappiness. 

A wonderful work could be done for a child of this 
nature if training is begun at birth. Unfortunately, too 
often this training devolves upon an overworked mother, 
herself almost a nervous wreck, not equal to the under- 
taking. Impress upon her the necessity for regular 
nursing; better, put the baby under the care of a special 
nurse. Be sure that the mother gets plenty of sleep and 
fresh air. Relieve her of all responsibilities possible. Be 
even more careful to see that baby's nutrition is kept nor- 
mal ; weigh before and after nursing, to know that he has 
enough. Supplement the breast as soon as it is indi- 
cated. Do not let him be fondled or played with. Make 
him lie in bed except when nursing. Accustom him to 
sleeping under varied circumstances — without a fooler, 
with and without light, without rocking, with and with- 
out noise. It can be done. Even throughout childhood, 
never allow him to miss his midday nap, or rest, even 
if he will not sleep. Establish an early, regular bed 
hour, and do not deviate from it. 



Good Habits 105 

Allow no excitement before retiring. Do not permit 
anyone to scare him with ghost tales, or teach him to be 
afraid of the dark. Read soothing stories to him. Make 
him eat regularly, masticate thoroughly. Give sweets 
only after a meal, especially forbidding ice cream and 
soft drinks between times. 

Do not teach him to be a "stunt" child. If he naturally 
wants to sing or recite, there is no harm in it; but it 
should come naturally. His progress at school must not 
be forced. Such a child can often make two grades in a 
year. If it does not interfere with his regular bed hour, 
his regular exercise, and his appetite, it is entirely per- 
missible. Such nerve force is a wonderful power: if 
properly directed, a blessing; if allowed to run riot, a 
danger. Training should begin at birth, but it is never 
too late to improve him. 

Good Habits 

All children can be trained to acquire the following 
good habits, provided they are healthy and properly 
nourished : 

1. To wake at feeding time. 

2. To go to sleep without rocking, without foolers, 
with and without lights, with and without noise. 

3. To take freely plain water, not sweetened. 

4. To sleep all night after four months of age, if not 
earlier. 

5. To have bowel actions regularly. 

6. To control the bladder even as early as four 
months. 

7. To amuse themselves. 

8. To obey. 

9. To expose their throats for daily inspection. 
10. To put away toys after playing. 



106 Care and Feeding of Southern Babies 

11. To hang up clothes after undressing. 

12. To regard the doctor as a friend. 

13. To eat what is good for them. 

Bad Habits 

Though often begun as a sign of hunger, thumb or 
finger-sucking becomes a habit. Young children may be 
Thumb or broken by using a long-sleeved dress and pinning 
Finger it to the mattress, or by tying a pasteboard splint 

Sucking around the elbow to prevent bending the arm. In 
older ones, wind around the thumb or finger a narrow 
strip of adhesive plaster, which may be soaked in a solu- 
tion of quinine. There is little to be expected from the 
bitter applications alone; they lick them off and continue 
sucking, but the bitter sticks longer to the adhesive plas- 
ter. Putting the hands in bags may succeed, but the use 
of aluminum mits, procurable at any surgical instrument 
shop, is the surest method. Do not frighten him by tell- 
ing him the doctor will have to cut his thumb off. 

Nail-biting is corrected in the same way. The earlier 
the treatment is begun, the quicker the cure. It is an 
Nail-bit- evidence of an overwrought nervous system. It is 
,n 9 an ugly habit and may persist through life. 

The pacifier habit, obviously forced upon babies, not 

self-contracted, indicates that something was wrong in 

the child's early months. If he was hungry, it cer- 

or^bolera tam ^y did not help; if he had colic, it only served 

as a temporary pacifier, and so helped the family, 

not the baby. He could not tell his troubles and suck a 

fooler at the same time. The cause of crying should have 

been found and corrected, making the fooler unnecessary. 

It is continually dropping on the floor, thus probably 

infecting the mouth. If you must use it, boil it daily, 

rinse in boric acid water when dropped; or better, tie a 



Bed-Wetting 107 

string to it and pin to the baby, so it will not reach the 
floor. While a fooler for a short time may do little harm, 
its prolonged use disfigures the teeth, causing the upper 
ones to protrude, an unsightly deformity. 

Some children, usually from three to six years, have 

the horrible habit of dirt-eating. They will eat anything: 

dirt, chalk, plaster, coal, ashes, stones. They are 

Dirt-eat- usually pale, anaemic, and nervous. Bring them 

up to normal (see "The Nervous Child," page 103) 

and stop the habit by main force. 

Some babies in the second year are never satisfied 
unless sucking a cracker, or zwiebach — a most pernicious 
habit, and one that may cause considerable diges- 
er C Hal?t ** ve disturbance. Give their meals at regular in- 
tervals. See that they finish within a half hour, 
and have nothing between times. 

Masturbation is common in children about the second 
year, especially girls. There is no way of breaking it 
except by watchfulness and tact. Have an exam- 
bation P " ination made to eliminate any source of irritation. 
A leather cuff around each leg near the knee con- 
nected by a wooden bar between them usually prevents 
by keeping the legs separated. In boys, circumcision will 
cure. Children should be taught from early infancy not 
to touch their genitals. 

Bed- Wetting, or Eneuresis 

The natural instinct when the bladder is full is to 
empty it, a function which does not require brain activ- 
ity. As the intellect develops, he learns to recognize the 
full feeling in the bladder, to know that it is not proper 
or comfortable to wet his clothing or bed, and uses the 
commode. The bladder is thus brought under the con- 
trol of the brain. It is astonishing how early a baby 



108 Care and Feeding of Southern Babies 

can be trained to urinate when held out at stated times. 
After a very few days training, he will learn to show by 
some signal when the bladder is full. At one year, cer- 
tainly at eighteen months, he should be trained; if not, 
he is to be classed as a bed-wetter. The worst bed-wet- 
ters are those who have learned bladder control at the 
usual time, and for some reason relapse into baby habits. 

Two causes may prevent successful training: (1) if the 
child is mentally deficient, there is not brain enough to 
train, and baby habits persist; (2) any serious bladder 
trouble, such as stone, inflammation, or even intensively 
acid urine may cause such a sudden, irresistible demand 
to void urine that it cannot be deferred. 

The usual history of a bed-wetter is this: normal blad- 
der control was acquired at one year, and retained until 
the age of three or four. He is a nervous child, plays 
with the family for two hours before retiring, is per- 
fectly well otherwise; takes a great deal of exercise and 
fresh air, and retires at nine, exhausted and excited. 
In such cases, there is no organic disease. His brain 
has been too busy during the day; he is worn out and 
the call of a full bladder is not strong enough to 
awaken him. He is too occupied with other things to 
take care of it. He has forgotten that part of his edu- 
cation and has to be trained over, and it is much 
more difficult than at first. Besides, from the lack of 
distension, as it has been emptied) unconsciously at the 
least provocation, the bladder is smaller than normal. 

Drugs offer but little assistance in curing bed-wetting, 

and should be resorted to under a physician's directions, 

after other methods have failed. Punishments do 

Treatment no good and are not justifiable. Rewards are 

much more satisfactory. The following routine, 

if persisted in, will finally correct the most obstinate 

case, provided the brain and bladder are normal: 



Bed Wetting 109 

1. Examine the urine, to exclude disease. 

2. Give little sweets or meats, as these make the urine 
more irritating. Asparagus and raw apples may have 
the same effect. 

3. Correct constipation, which throws more of the 
burden of elimination on the kidney. Also the presence 
of a huge lump of feces in the lower bowel may produce 
pressure on the bladder. 

4. If adenoids are present to any extent, remove them. 
If there are evidences of pin worms, such as irritation 
or itching about the rectal opening, see your physician. 
If there is a very tight, adherent foreskin, circumcision is 
recommended, though this operation will not usually 
have the brilliant results expected. 

5. Insist upon an early, regular, not excited bedtime; 
no picture shows or other nerve-straining diversions. 

6. Do not let him sleep on his back. This causes the 
full pressure of the urine on the sensitive base of the 
bladder. Tie a towel around the body with the knot at 
the back, or sew a marble in the back of his gown. This 
will make him lie on his side. 

7. Give all the water and fluids you can get him to 
drink up to 5 P.M. This makes the urine bland and 
unirritating; after 5 P.M., allow as little fluid as possi- 
ble. No milk for supper. 

8. Make him urinate at his bedtime. Some very ner- 
vous little fellows are so preoccupied that they forget it, 
or only partially finish. Take the child up at your bed- 
time, having the chamber always at the same convenient 
place. If necessary, with an alarm clock wake him at 
intervals during the night, usually once or twice is 
enough, and this after a few nights may be dispensed 
with. 

9. Finally, train his subconscious mind into the fact 



110 Care and Feeding of Southern Babies 

that the habit must be broken, by making him repeat just 
before retiring, "I am too old to wet the bed; I am not 
going to do it tonight." 

Day bed-wetting, or clothes-wetting, is harder to break 
than the night habit. It requires constant watching and 
training to pass urine at stated intervals, which should 
be gradually prolonged. 

Circumcision 

Circumcision is not absolutely necessary in every case. 
If the foreskin can be easily drawn back (do not let it 
stay back — it will swell and cause trouble) the operation 
is not urgent. The choice time for the operation is after 
the age of three weeks, when there is no longer danger 
of continued bleeding from the lack of clotting power 
of the blood, sometimes seen in young babies; or before 
four months of age. In this interval, the operation can 
be done quickly, as no stitches are needed and no anaes- 
thetic is used. After this, bleeding usually necessitates 
stitches, prolonging the operation, and an anaesthetic is 
required. If neglected in early infancy, unless the indi- 
cations are urgent, it is best to defer it until the child is 
old enough to cooperate in the care of the wound. If 
done in early childhood, the nervous shock of the opera- 
tion and subsequent dressings strike terror to him. Do 
not forget, however, to attend to it should there be any 
other operation — such as the removal of adenoids — re- 
quiring an anaesthetic. 

Bad Colds 

Many children are, through heredity, subject to catch- 
ing colds, but more often through lack of hygienic and 
dietetic care. The way to relieve a cold is to prevent it. 
That colds are infectious one would hardly deny, and 
their prevention does not lie in drugs or vaccines, but in 



Bad Colds 111 

building up the child to resist this tendency to infection, 
inherited or acquired. Avoid infection if possible. Do 
not allow babies to be kissed in the mouth. Every child 
from birth should have his own handkerchief. Do not 
rely on sprays or antiseptics. Any antiseptic strong 
enough to kill germs will probably erode the mucous 
membrane, which is nature's shield against invading 
germs. One cannot get entirely away from germs; they 
are everywhere. Not that one should purposely run into 
them, but strive by proper living to render oneself 
strong enough to resist exposure to infection. 

When one talks in an ordinary tone of voice, the air 
is sprayed at least one foot, with droplets of saliva con- 
taining the germs of his throat and lungs. A 

Modes of louder tone will carry them two or three feet, 
infection i . , J c r ^ 

coughing and sneezing as tar as six teet. Lxper- 

toratedj material dries, becomes mixed with dust, and is 
so inhaled. These, with the common drinking cup and 
the family handkerchief, are the great sources of infec- 
tion. 

Sunlight and air are the great antiseptics, as few germs 
can stand exposure, but the individual power of resis- 
tance is the chief preventive of disease. A well- 
tion Ven " balanced ration and plenty of fresh air and sun- 
shine increase this power. Avoid chilling 
drafts, but get fresh air day and night. Avoid dust and 
coughing crowds. 

A cold sponge bath will improve the circulation and 

help some children, over two years, who are predisposed 

Cold to colds. If once begun, it should be kept up regu- 

Sponge larly as nearly as possible under the same condi- 

Bath tions. This has nothing to do with the cleansing 

bath, which is given first, then a pitcher of cold water is 

thrown over the shoulders. In winter, it may be tern- 



112 Care and Feeding of Southern Babies 

pered some. Then rub briskly with a crash towel. If 
the child reacts quickly, and is red and rosy, it will do 
him good; if chilled and blue, it is too severe; if feet 
only are cold, try letting him stand in a tub of warm 
water while the douche is thrown over him. 

An emulsion of cod-liver oil is often quite beneficial. 

Children take this readily, especially if it is made with 

chocolate. It should be given one-half hour be- 

Tonlc8 fore meals, only in cool weather, and only when 

digestion is in fair condition. 

There is little to be done to help a contracted 
Treatment cold. Lighten the diet, give a free laxative and 
of Colds pl ent y f f resn a i r . Do not overheat. 

Cough mixtures are justifiable only to secure rest at 
night. Do not try to stifle a cough. Children cannot 

spit until four years of age, and it is eight years 
Mixtures b e f° re they can get rid of all the excretions 

coughed up. Coughing is their only method of 
keeping the lungs clear. Stopping the cough does not 
cure the condition; rather hinders it. Camphorated oil 
or mustard paste applied to the chest is often soothing. 
If there is fever, the cold has reached a dangerous stage, 
and requires a physician. 

Adenoids and Tonsils 

The discussion of colds brings up the unpleasant but 
ever recurring subject of adenoids and tonsils, which 
every mother has learned to dread. The accompanying 
cut shows the location of these much abused structures. 
With frequently recurring bad colds, often the product 
of faulty hygiene and diet, the adenoids and tonsils may 
become enlarged as the result of the repeated inflamma- 
tion. The popular craze for the removal of these organs 
demands some comment. 



Adenoids and Tonsils 



113 




Diagram illustrating the normal throat and nose and the changes 
produced by adenoids. (Truby King.) 

No operation in surgery, in selected cases, is followed 
by such strikingly beneficial results, but it does not sig- 
nify by any means that every child should be deprived 
of adenoids and tonsils, even though it may be a simple 
operation. 

The adenoid membrane is the natural mucous cover- 
ing of the back of the nose, and the upper pharynx, and 
when subjected to repeated inflammation, becomes thick- 
ened, and fills up this passage with its overgrowth, which 
is called adenoids. They are back of the nose and above 
the throat and tonsils. The enlargement can rarely be 
seen, but is easily felt with the finger by hooking it back 
behind the palate. Note that opening into the adenoid 
membrane on either side is the Eustachian tube, leading 



114 Care and Feeding of Southern Babies 

to the middle ear, and it is through this tube that infec- 
tion readily extends to the ear. 

Adenoids cause symptoms formerly described as 
chronic catarrh, with its tendency to deafness and ear 
Symptoms infections. Adenoids produce a nasal voice, and 
of Ade- by obstructing the normal breathing through the, 
noids nose, cause snoring during sleep, mouth-breath- 

ing and flattened chest, and irregular teeth due to the 
deformed dental arch. The removal of the adenoids 
means the scraping off of this excessive growth, leaving 
the membrane only in its normal thickness. It is a sim- 
ple operation and one of great value when necessary. 
Every child with an acute cold has the symptoms of ade- 
noids, but they should disappear as the inflammation 
recedes. 

The indications for the removal of adenoids are: (1) 
A tendency to deafness or a history of repeated ear in- 
flammation, possibly abscesses; (2) persistent signs of 
nasal obstruction, lasting after all evidences of acute 
cold have disappeared — such as mouth-breathing, de- 
formed dental arch, flattened chest, snoring at night; 
(3) persistent nasal catarrh. 

Tonsils 

The function of the tonsil is not understood, though 
many unproved theories explaining its purpose have 
been advanced. We only know that it is largest in size 
about the age of six, then begins to shrink, and at twen- 
ty-one, should be a small mass of fibrous tissue. From 
this, the conclusion seems justifiable that whatever func- 
tion it may have is largely over after the age of seven, 
and this would justify the statement that unless condi- 
tions are urgent it is not best to remove tonsils before 
seven years of age. 



Prickly Heat 115 

These are the indications for removal of the tonsils, 
rather than simply their size: One cannot tell the exact 
state of the tonsil by its appearance; the history of the 
case is more important. 

1. Recurring attacks of tonsilitis. 

2. The history of previous tonsilitis with resulting 
infections, such as rheumatism, heart or kidney inflam- 
mation. 

3. Extremely large tonsils, partially obstructive. 

4. In older children, tonsils should not be left in 
when adenoids are removed. Adenoids recur frequently 
under any circumstances, almost certainly if the tonsils 
remain. 

Prickly Heat 

This is a common eruption, characterized by redness 
of skin with slightly raised pimples, and is seen in hot 
weather. It usually comes on the tender skin of the neck, 
armpits, or groins, but may almost cover the body. 

Dress lightly and have no woolen stuff in contact with 
the skin. If heavier clothing is necessary during cool 
mornings and evenings, use outside wraps, easily 
Treatment recognized as too hot for midday, and removed. 

Some babies cannot stand soap in the summer, 
and the bran bath must be constantly used. If the bran 
baths, correct dressing, and plenty of powder do not re- 
lieve prickly heat, make this application after the bath, 
or several times a day if necessary: Two drams each of 
zinc oxide, prepared calamine, and glycerine in four 
ounces of milk of magnesia ; mix and apply locally with 
a cotton swab. 

Chafing Buttocks 

Chafing may be due to too much soap or washing pow- 
der left in the napkin. In rare cases, irritating urine is 



116 Care and Feeding of Southern Babies 

the cause, occurring especially if a rubber diaper is con- 
stantly used. Ordinarily it is a sign of fermenting food 
and indicates that there is too much sugar in the food. 
Nothing will permanently relieve it but correcting the 
diet. In itself it is not so serious, but it means that the 
lower bowel is also chafed and congested, a tendency to 
dysentery. 

Sore Mouth; Sprue or Stomatitis 

In infancy, three forms of sore mouth are seen: 

1. Red ulcers appearing in the back of the roof of the 
mouth, due to bruising by over vigorous mouth washing 
soon ofter birth. If baby thrives, these disappear rapid- 
ly and need no treatment. 

2. By far the most common form of sore mouth is 
thrush. A white flake resembling a film of milk appears 
on the inner side of the cheek and rapidly spreads, even 
over the entire cavity. It is rare in healthy, well-fed 
babies. It is probably caused by a dirty nipple or paci- 
fier which has been dropped on the floor. If the mouth 
is healthy, it will resist infection, but if improper diet 
causes over-acidity or congestion, the infection starts 
readily. Prevention is better than cure. Keep dirty 
things out of the mouth, and adjust the diet properly. 
If infected, paint the spots several times daily with a 
solution of chlorate of potash — a teaspoon to a glass, 
using a match with cotton twisted around it. If accus- 
tomed to a pacifier, make a virtue of it by dipping in 
the boric acid solution frequently, thus making an anti- 
septic application. If not better in twenty-four hours, 
call the doctor. 

3. The third form of sore mouth, fortunately rare, is 
that due to scurvy, caused by prolonged use of preserved 
or boiled milk, or patent foods, and the neglect to correct 



Intestinal Parasites 117 

their want of freshness by giving orange juice. This 
sore mouth is characterized by swollen, bleeding gums, 
especially about the margin of the teeth. It is also asso- 
ciated with a train of symptoms resembling rheumatism. 
If the gums bleed, give orange juice and call the doctor. 
In older children, these exquisitely tender little ulcers 
or blisters may appear on the tongue, on the gums, or 
Canker on tne mner surface of the lips. The margin of 
Sores the gum is often swollen and bleeding. There is 

Aphthous complete loss of appetite, attempts to eat produc- 
Stomatitis « n g g reat p am . The cause is an unbalanced diet — 
an excess of sweets or starches, associated probably with 
taking too little water. 

This condition does not indicate calomel or any 
strong purgative. Restrict the diet absolutely to liquids. 
If a laxative is needed, give milk of magnesia. The 
same application suggested for thrush (see above) should 
be used. If the ulcers are touched with 10 per cent 
argyrol solution, the sensitiveness is greatly relieved. 

Intestinal Parasites 

Children under two years are rarely infected with 

worms, though it is a common condition in older ones, 

especially if they live in the country, but even 

Wor there, owing to improved sanitary conditions, they 

are not seen so often as formerly. The presence 

of a worm must mean the previous existence of a worm 

egg in the intestinal tract. It cannot come from dietetic 

errors. 

The round worm is the one referred to by the indefinite 
term "Worms." The egg is taken in by drinking infected 
water or by eating fruit off the ground, or by putting 
sticks in the mouth. 

There are no definite symptoms of worms. Diminished 
or capricious appetite, furred tongue, large abdomen, 



118 Care and Feeding of Southern Babies 

picking the nose, restless sleep and constipation are sug- 
gestive, but are more often due to intestinal indigestion 
from improper diet, or faulty mastication. The only 
positive sign is the passage of a worm, which usually 
means there are more, or the finding of worm eggs in 
the stool by a competent microscopist. 

Giving worm medicine is by no means a harmless pro- 
cedure, and should be ordered only by a physician. 

The tapeworm is a rare occurrence, in children espe- 
cially. The egg is usually taken in raw meat. Do not 
use raw beef juice; see that all meat is cooked 
worm tnorou ghly — not necessarily well done, but enough 

to kill worm eggs. There are no positive symp- 
toms of tapeworm. There may be malaise, a loss of flesh, 
and some digestive disorder, but all these are indefinite. 
The diagnosis is made by finding sections of the worm 
passed in the stools or escaped upon the clothing, or 
by finding the egg. In size and shape, these sections re- 
semble a pumpkin seed. They may appear singly or 
several sections may be united end to end. A full grown 
worm is twenty feet long. The treatment is too elabor- 
ate for this treatise. 

Pin worms, thread worms, or seat worms are about one- 
third of an inch long, very like a piece of white thread. 
Usually they live in the lower rectum, and can 
?7! n often be seen clinging to a formed stool. The 

prominent and almost only symptom is intense 
itching about the rectal opening. 

The hookworm is rod-shaped, about three-eighths of 

an inch in length, with a bent or crooked end. The usual 

mode of entrance into the body is through sores 

worm" on ^ e ^ eet °^ c hil°' ren living in infected regions. 

The hookworm has more decided and serious 

effects upon the patient, child or adult, than any other 



Rectal Prolapse 119 

parasite. Among the many symptoms could be men- 
tioned: Severe anaemia (the pallor is intense), lack of 
energy, affecting growth and mentality, usually a diar- 
rhoea, with loss of appetite. The parasite may be found 
in the washed strained stool, but a microscopical exam- 
ination of the feces is the surest method of diagnosis. 
County and State Boards of Health employ trained mi- 
croscopists who will make such examinations, usually 
without charge if you cannot get it done otherwise. Of 
course, the treatment must be directed by the physician. 

Rectal Prolapse (Often Called Piles) 

Rectal prolapse is frequently seen in relaxed, weak 
children, after an illness, especially diarrhoea, when the 
sphincter, or purse-string, muscle closing the bowel is 
relaxed, and the mucous membrane lining the bowel sim- 
ply rolls out after a straining action. It is not serious 
and is easily corrected temporarily, but only permanently 
cured when the child regains strength and muscular 
tone. It is not a form of piles. 

Keep the stools mushy; not loose, not hard. Do not 
allow straining nor permit him to sit at stool a long time. 
If necessary, make him have the action lying down, 
Treatment using a napkin; sometimes a piece of adhesive 
plaster may be strapped across the buttocks, hold- 
ing them together during the action. Give nutritious food 
and build up as rapidly as digestion permits. The pro- 
trusion at the anus recedes usually in a few moments; 
but if it does not, raise the child by the feet, standing 
him on his head and shoulders, and gently touch the pro- 
truded membrane; it will easily go back. 
Sore Eyes 

Pink eye is a common occurrence in babies. The eye 
or eyes are red and congested and there is an increased 
secretion of mucus or pus. 



120 Care and Feeding of Southern Babies 

To prevent it, the lids should be sponged with cotton 
each morning to remove the night secretions and at bed- 
time to get rid of the dust of the day, using boiled 
Tlon Ven " water or boric acid solution. Do not put anything 
into the eye; simply wash the lids. Avoid the 
bright sunlight. See that the source of light is from be- 
hind him when sleeping or resting. 

To relieve pink eye, dissolve a level teaspoon of 

boric acid in eight ounces of water; every two hours fill 

the little depression at the corner of the eye next 

Treatment to the nose, then pull the lids apart slightly and 

let the solution run in on the eyeball. If not 

greatly improved after a day's vigorous treatment, see a 

physician. 

"Inactive Liver or Bilious Spells" 

So-called bilious attacks are frequently seen in arti- 
ficially fed babies and young children. The liver is not 
at fault. The food does not suit and intestinal fermenta- 
tion is the result. 

There are loss of appetite, foul breath, coated tongue, 
sallow complexion, nausea, slight fever, and whitish 
stools. 

Give a light laxative and restrict the diet absolutely 

to liquids for a day or so. Digestive power is quickly 

restored after this rest, and he is soon normal 

Treatment again. Don't be satisfied with a dose of calomel. 

Analyze his previous feeding and find out why 

such a condition should have developed. The error in 

diet will probably be discovered and the recurrence of 

such spells prevented. 

Nursing Cap, or Seborrhoea 

Seborrhoea is a dark, yellowish crust on top of the head, 
possibly covering the entire crown; is seen frequently 



Nursing Cap 121 

under six months. It is not dandruff. The usual cause 
is neglect to properly cleanse the soft spot in the head, 
through fear of harming the baby, then after the crust 
appears it is aggravated by too persistent and forceful 
efforts to cleanse it with soap and by rubbing. 

Apply every night olive oil or vaseline; next morning, 
remove such scales as may be loose and bathe in bran 
water. Use no soap. 



CHAPTER IX. 



MISCELLANEOUS 

Starting Baby Correctly 

Baby's first days are so fraught with" dangers that at 
the risk of repetition a summary of some of the many 
important points to be watched is here given: 

1. See that serious eye infection is prevented by drop- 
ping silver solution in the eyes soon after birth. 

2. Give at once an oil rub and a quick, cleansing bath, 
care being taken to preserve body heat. Do not use 
strong soap or have the water too hot. In very weak 
babies, the maintenance of body heat is so important 
that the bath must be omitted or modified until he is 
stronger. 

3. Weigh carefully and regularly. There is a loss of 
about one-fourth to one-half pound during the first four 
or five days. By! the end of the first week he should 
begin to gain and continue to do so. 

4. Give only warm boiled water during; the first two 
days, one tablespoon every two or three hours while 
awake. Do not use a bottle and nipple at first. It draws 
so much easier than the breast that it may wean from the 
breast. 

5. There is no need of teas or purgatives. The stools 
are naturally blackish green at first. He may be jaun- 
diced, but drugs only aggravate the condition. 

6. Put to both breasts every six hours for five min- 
utes each. Do not let the mother hold him there longer; 
it injures the nipple. After the secretion of milk begins, 
then use one breast at each nursing interval, alternately 
at 6, 9, 12, 3, 6, 9 or 10 and 2, Wake in the day at 



Starting Baby Correctly 123 

nursing time. Never allow nursing more than twenty 
minutes nor less than ten minutes. 

7. Give one-half to one ounce of warm boiled water 
between several nursings. After the first month, it may 
be taken from the bottle and nipple. 

8. Watch the stools for yellow stains, the signs of 
digested milk, which should appear about the fourth day. 

9. The urine is scanty at first, sometimes none for 
twenty-four hours or longer. The first urination may be 
quite painful and show a brick-dust sediment on the nap- 
kin, which may explain much previous crying or fretting. 
Give plenty of water, which will relieve or prevent this 
condition. 

10. If there is any doubt about there being enough 
milk in the breast to satisfy, weigh accurately before and 
after nursing and know how much is withdrawn. This 
is especially necessary in frail babies, not strong enough 
to draw, who might otherwise starve with plenty at 
their door. 

11. See that baby is kept warm. If necessary, use 
hot applications, not touching, but near him. 

12. Take the temperature in the rectum three times a 
day. If it is subnormal, it means too little food, or not 
enough covering or artificial heat. Fever means that he 
gets too little fluid, water or milk, or too much artificial 
heat, or it may be due to the beginning of an infection. 

13. For twenty-four hours after birth baby should lie 
on the right side. After this, it is important to see that 
the position is changed frequently, so that the habit of 
lying in any one position is not formed. 

14. Do not allow nervous excitement for the mother; 
company only sparingly, when necessity compels. 

15. It is best for baby to be kept in an adjoining 
room, so that every movement will not disturb his mother. 



124 Care and Feeding of Southern Babies 

Don'ts 

Don't start the pacifier habit. 

Don't put sugar in baby's drinking water. 

Don't neglect weekly weighing. 

Don't mistake hunger or thirst for colic. 

Don't sleep with the baby. 

Don't take him up every time he cries. 

Don't make the child a toy for adults. 

Don't give tastes of forbidden foods. 

Don't wean for deficient quality or quantity of breast 
milk. Try to remedy the defect and make use of every 
drop with its wonderful nutritive and immunizing power. 

Don't wean before the end of the first year unless im- 
perative. 

Don't attribute illness to teething. 

Don't lift by the arms. The shoulder might be dislo- 
cated. 

Don't suggest pain. If suspected in any part of the 
body, press on it or move it and watch his expression. 
Don't ask if it hurts. 

Don't complain before a child; it's catching. 

Don't permit a child to sit up after his regular bed 
hour. 

Don't let him go to bed excited by play or story. 

Don't bribe him to obey. 

Don't tell a child a lie. If you make promises, fulfill 
them. 

Don't give thoughtless commands. 

Don't let him eat when excited or exhausted. 

Don't let him specialize in one article of food. Teach 
him to eat everything. 

Don't show temper while administering punishment. 

Don't try to follow every adviser. 



Table of Development 125 

Table of Development 

A thriving child should accord with these standards of 
development. 

Read down to the age of your child and see if he is 
normal. 

At birth : Weight, seven to seven and one-half pounds ; 
length, twenty and one-half inches; head, thirteen and 
one-half inches in largest circumference. Will grasp fin- 
ger. Eyes dull blue. 

One month : Can hear ; will follow light with eyes. 

Two months: If artificially fed, should take three to 
four ounces every three hours, half milk with one ounce 
of added sugar to twenty-four hour quantity. 

Three months : Weight, eleven pounds ; length, twenty- 
three and one-half inches; first voluntary movements; 
recognizes his mother's voice; saliva and tears begin; 
eyes begin to change to permanent color. Begin to train 
to have regular stools. 

Four months: Can hold head erect; should change 
to short clothes; first hair begins to shed. Discontinue 
midnight feeding. Should take two-thirds milk with one 
and one-half ounces of sugar in twenty-four-hour quan- 
tity; five or six ounces every three hours for six feedings. 
May begin orange juice carefully. 

Five months: Plays with toys; laughs and "crows." 

Six months: Weight, seventeen pounds; length, twen- 
ty-six and one-half inches. The two lower central incisor 
teeth appear. May take three-fourths milk. 

Seven months: Can sit propped up with a pillow. 

Eight months: Can sit alone. Upper central incisor 
teeth appearing. Should take full milk in winter; eight 



126 Care and Feeding of Southern Babies 

ounces, four-hour interval, five feedings, 6, 10, 2, 6, 10, 
or the three-hour intervals, 6, 9, 12, 3, 6. 

Nine months: Weight twenty pounds; length, twenty- 
eight inches; four teeth; attempts to stand. If entirely 
breast-fed, must now start one artificial feeding daily. 
May start beef juice; may suck toasted bread for ten 
minutes before or after a nursing. 

Ten months : May crawl, if he ever does. 

Eleven months: Speech begins — single words. 

Twelve months: Weight, twenty-one pounds; length, 
twenty-nine and one-half inches; six or eight incisor 
teeth; can stand alone. Should control the bladder. 

Fifteen months: Weight, twenty-three and one-half 
pounds; length, thirty and one-half inches; twelve teeth. 

Eighteen months: Weight, twenty-four and one-half 
pounds; length, thirty-one and one-half inches; sixteen 
teeth. Fontanelle should be closed. Must walk by this 
age. 

Table of Heights and Weights 

Boys 
AGE Height 

Ins. 

Two years 34 

Two and one-half years 35 

Three years 37 

Three and one-half years.... 39 

Four years 39 

Five years 42 

Six years 44 

Seven years 46 

Eight years 48 

Nine years 50 

Ten years 52 



m 


Girh 


i 


Weight 


Height 


Weight 


. Lbs. 


Ins. 


Lbs. 


27 


33 


26 


29 


35 


28 


32 


37 


30 


34 


38 


32 


36 


39 


34 


41 


41 


40 


45 


43 


43 


50 


45 


47 


54 


4S 


52 


59 


49 


57 


65 


51 


62 



Recipes 127 

Recipes 

Rub into a paste two rounded teaspoons of barley 
flour (Robinson's, Brooks' or Johnson's can be purchased 
at any drug store). Add to a pint of boiling 
^ r J ey water in a double boiler and cook for thirty min- 

utes. Replace the water boiled out so that there 
is a pint when finished. Strain through muslin. It keeps 
fresh on ice for twenty-four hours. 

Rice water, wheat, oatmeal water (or barley water 
using barley grain), is made the same way, except that 
it should be boiled at least two hours. Replace the water 
boiled out and strain through muslin. 

For older babies, twice this strength of cereal 
Gruels ma y ^ e use d- I' tends to jelly on cooling and is 

called cereal gruel. 

Cracker tea or toast water: This is of about the same 

food value as a cereal water, but can be made quickly 

and is much more convenient. Pour one pint of 

Tea 6P boiling water over two toasted white crackers or 

one piece of toast or zwiebach, allow to stand five 

minutes, strain through muslin. 

Cereal waters are insipid, and when ordered as a 

steady diet, especially for babies over seven months, they 

Flavoring are not we ^ taken. They may be made palatable 

Cereal by the addition of a few drops of vanilla and 

Waters sugar (unless contra-indicated, when saccharine 

may be used as a sweetening) , or a tablespoon of orange, 

grape, or lemon juice may be added to each eight ounces. 

These fruit juices seem to have no bad effect, even in 

diarrhoeal conditions. One tablespoon of strong tea or 

coffee to each eight ounces will induce a child to take 

it when otherwise refused. Of course, tea and coffee 

should not be given regularly to children, but sick 



128 Care and Feeding of Southern Babies 

babies often need a stimulant, and there is none better 
than caffeine. 

Babies show decided preference in cereal waters — some 
will take one and refuse all others. Rice water is prob- 
ably the favorite; cracker tea next. 

Albumen water: Stir (do not beat — the froth is not 

palatable) the white of a fresh egg in six ounces of cool 

water; add a pinch of salt, a little sugar, and a 

Albumen teaspoon or more of fruit juice. If given in 

bottle, it should be strained through cheesecloth. 
Feed cool or only slightly warmed. This is quite useful 
to relieve vomiting. 

Do not use canned beef extracts. Broil a steak slightly 

on both sides and press out the juice with a lemon 

squeezer or meat press. More can be obtained if 

Juice ^ e stea k * s g roun d before broiling. Two to four 

ounces is the average amount from a pound of 

meat. It is more beneficial as a stimulant and tonic than 

as a food. The food value of an ounce of steak juice is 

only eleven calories, equal to that of one-half ounce of 

milk, while an ounce of scraped beef supplies sixty-five 

calories, or as much as three ounces of milk. The real 

nutrition of beef lies in the coagulated albumen of the 

fiber, not in the juice. 

Cold process beef juice may contain tapeworm eggs. 
It is more economical and just as nourishing as the steak 
juice, but should not be given children. 

Animal broths: One-half a pound of chicken, beef or 
mutton, containing some bones, is put in one pint of water 
and boiled over a slow fire for two hours, adding 
Broths water as it is boiled out. Skim off the grease after 

cooling, salt, and serve warm. Rice flour or arrow- 
root may be used as thickening, and if the child's condi- 



Recipes 129 

tion permits it, four ounces of milk may be added to the 
broth. 

Strained soup : Make in the same way as broth, except 
that a soup bunch — carrots, spinach, parsley, okra or 
onions — may be cooked with it and strained out. 
Soup In this way the extract of the vegetables, contain- 

ing half their mineral salts, is obtained without the 
risk of giving the pulp. 

The food value of vegetables lies chiefly in the mineral 
salts they contain, such as iron and phosphorus. Baby 

is supplied with iron in his body at birth, sufficient 
tables ^ or t ' ie ^ rs * y ear * Milk has a negligible quantity 

of iron. About the end of the first year this stored 
up supply has given out, and if milk-fed alone, he soon 
becomes pale and anaemic, and vegetables afford the best 
source of assimilable iron. If boiled in water, vegetables 
lose about one-half their salts by becoming dissolved into 
the water. The proper way to cook green vegetables to 
retain their full value is by steaming them over water, 
not in it. 

Thirty or forty minutes is long enough to cook them. 
More than this toughens the fiber. In the summer, when 
we do not dare to use the vegetable pulp with children 
under three years of age, the extract of vegetables may 
be safely given by using vegetable soup, thus obtaining 
one-half their salts value without the dangerous fiber. 

Coddled egg: Drop a fresh egg into boiling water. 

Remove the vessel from the stove, or turn out the gas. 

In eight minutes it jellies through and through. 

Eggs If preferable, it may be broken into the boiling 

water, which makes coddled poached egg. 

A hard-boiled egg should be cooked at least twenty 



-9 



130 Care and Feeding of Southern Babies 

minutes, through the pasty into the mealy stage. Mash 
the yolk with butter and spread on bread. 

Scraped steak or meat pulp: Scrape the raw steak 

with a table knife and broil the scrapings in butter as a 

sausage. Any steak may be scraped. Less fiber is 

Steak* obtained from a tough one, but the scrapings are 

all tender. Ground steak is almost as good, but 

the meat must be carefully selected, as everything passes 

through the grinder. 

Spoon bread, mush bread, or batter bread: One cup 
of white cornmeal ; two cups of sweet milk or water ; two 
Spoon eggs; one level teaspoon of baking powder; one- 

Bread fourth teaspoon of salt. Beat the eggs slightly, 

add the meal, sifted with the baking powder and 
salt. Add milk slowly, stirring constantly. Heat in a 
pan one tablespoon of butter or lard and when boiling 
hot pour in the batter and cook in a quick oven until 
brown. 

Buttermilk: Good, old-fashioned churned buttermilk 
is best, but difficult to obtain. Dairy buttermilk is ques- 
tionable. Home-made buttermilk is easy to make. 
".. er " Allow a quart of good fresh milk, not pasteur- 

ized, to stand in a warm place, temperature about 
85° to 95°, for twenty-four hours, until clabbered. Pour 
into a half-gallon fruit jar and shake for ten minutes. 
Remove the butter. A small glass churn will answer the 
same purpose, and is very convenient. 

A more reliable method is this : Remove the cream of 
the milk, boil three minutes, cool to blood heat, add some 
reliable buttermilk germ culture obtained at drugstores, 
set in a warm place until it clabbers, and churn as above. 
Buttermilk should always be kept on ice in sterile glass 
jars. 



Liquid Diet 131 

Liquid Diet 

Advised for all sick children over two years of age in 
any illness until the diagnosis is made and food pre- 
scribed by the physician: 

Boiled milk, which may be flavored with cocoa or 
postum, buttermilk, strained soup, orange juice, weak 
lemonade, pineapple juice, egg albumen, meat juice, 
cereal gruels, grape juice diluted with equal parts water, 
gelatine and home-made ice cream made of boiled milk 
not cream, junket, coddled egg, or boiled custard made 
of milk and egg. 

Solid or starchy foods, including toast and crackers, 
and cereals, are forbidden. 



INDEX 



PAGE 

Abdominal binder 10 

Abdominal pain 94 

Adenoids 71-112 

Airing 1 baby 14 

Airing nursery 9 

Albumen water 128 

Appetite, Loss of 68 

Artificial feeding 42 

Baby talk 23 

Bad habits 106 

Band, Abdominal 10 

Barley gruel 127 

Barley water 55-127 

Bath 15 

Bath, Bran 91-115 

Bath, Cold Ill 

Bath for fever 90 

Bath, Hot mustard 91-120 

Bath, Puddle 90 

Bath, Sponge 90 

Bathing ears 16 

Bathing eyes 16 

Bathing mouth 15 

Bathing sick child 84 

Batter bread 130 

Bed 10 

Bed-wetting 107 

Beef juice 56-128 

Beef, Scraped 130 

"Bilious" spells 120 

Birthmarks 102 

Biting finger nails 106 

Bleeding nose 98 

Bleeding wounds 100 

Boiling milk 44-46 

Bottle feeding 42 

Bottles 45 

Bottles, Care of... 47 

Bottles, Weaning from 62 

Bowel actions — See Stools. 

Bow legs 20 

Bran bath 91 

Bread 56-63 

Brest feeding — See Nursing. 

Breast milk 41 

Breast milk, Analysis 41 

Breast, Weaning from 39 

Breast milk withdrawn 41 

Broth 128 

Burns 99 

Butter « 65 

Buttermilk 68-130 

Buttocks, Chafing 115 

Canned vegetables 70 

Canker sores 117 



PAGE 

Cathartics — See Purgatives. 

Cereals 63 

Cereals, Uncooked 63 

Cereal gruels 127 

Certified milk 44 

Chafing buttocks 115 

Change to short clothes .... 11 

Chewing 69 

Circumcision 110 

Clothes, First 10 

Clothes, Short 11 

Clothes, Sleeping 13 

Clothes, Summer 12 

Coddled egg 129 

Cold sponge bath Ill 

Cold feet 10 

Colds 110 

Colds in nursing mother. ... 28 

Colic 32 

Colitis 80 

Complemental feeding 37 

Condensed milk 57 

Contagion 84 

Constipation 77 

Contra-indications to nursing 27 

Convulsions 97 

Cough mixtures 112 

Covers 10 

Covers, Kicking off 18 

Cows' milk 42 

Cracker habit 107 

Cracker tea 127 

Cream 49-79 

Cross-eyes 22 

Croup 95 

Croup. Membranous 97 

Crying 100 

Dandruff 121 

Deafness 113 

Decay of teeth 72 

Delayed speech 23 

Dentition — See Teething. 

Desserts 69 

Development 18 

Diarrhoea 80 

Diet for nursing mother. ... 27 

Diet, First year 26 

Diet, Second year 61 

Diet, Third year 68 

Diet, Summer 66 

Diet, Winter 67 

Diet lists 66 

Dirt eating 107 

Disorders caused by feeding. 76 

Don'ts 124 



II 



Index 



PAGE 

Dry milk 58 

Dysentery SO 

Ears, Protruding 102 

Ear, Foreign body in 99 

Earache 99 

Early waking hours 31 

Eggs 64-129 

Emergencies 93 

Emptying the breasts 30 

Enema 79 

Eneuresis 94 

Evaporated milk 58 

Excess of fats, sugars, pro- 

teids 54 

Exercise for motner 27 

Eyes, Care of 16-22 

Eyes, Inflamed 119 

Failing appetite 68 

Fat in milk -54 

Feeding from breast 26 

Feeding, Artificial 45 

Feeding, Bottles 47 

Food during first year 26 

Food during second year. ... 61 

Food during third year 70 

Feeding intervals 29-62 

Feeding, Mixed 37 

Fever 90 

Finger sucking 106 

First clothes 10 

Flavoring cereal waters .... 127 

Fontanel 21 

Food in illness 83 

Foods, Patent 82 

Fooler 106 

Forced feeding 87 

Foreign body in ear 99 

Foreign body in nose 99 

Foreign body swallowed.... 94 

Fruits 55-83 

Fruit juices 55 

Gain in weight 19 

Gas in stomach 76 

Germs 44-84 

Goats' milk 55 

Good habits 105 

Gravy 56 

Gruels 127 

Habits, Bad 106 

Habits, Good 105 

Habits, Nursing 28 

Hair 22 

Head, Holding up 20 

Head, Size of 20 

Heat, Prickly 126 

Heating nursery 9 



PAGE 

Height 19 

Herd milk 43 

Hernia at navel li 

Hookworm lis 

Hot bath 91 

Hot pack 91 

Hunger 34 

Hygiene of nursing mother. 26 

Indiscretions in diet 93 

Infant foods 56 

Illness, Care during 84 

Illness of nursing mother ... 27 
Injections — See Enema. 

Interval of feeding 48 

Intestinal indigestion 120 

Intestinal parasites 117 

Jaundice 122 

Kicking covers 18 

Knit bands 11 

Lime water 50 

Liquid diet 131 

Malt sugar 49 

Massage 78 

Mastication 69 

Masturbation 107 

Meat 64 

Meat, pulp 64 

Membranous croup 97 

Menstruation in nursing 

mothers 28 

Milk 41 

Milk after second year 68 

Milk, Boiled 46-57 

Milk, Dry 58 

Milk during second year.... 61 

Milk examination 41 

Milk, One cow's 43 

Milk, Herd 43 

Milk, Pasteurized 45 

Milk, Prepared 45 

Milk, Sterilized 44 

Milk, Summer changes in... 59 

Milk sugar 49 

Minor ailments 102 

Mixed feeding . . 37 

Mother's milk — See Breast 

Milk. 

Mouth, Cleansing of 71 

Muscular development 20 

Mush bread 130 

Mustard bath 91 

Mustard pack 91 

Nail biting 106 

Naps 16 

Napkins 13 

Nervous child 103 



Index 



III 



PAGE 

Newborn, Care of 53-122 

Night clothing 13 

Night feeding 30 

Nipples 45 

Nose bleeding 98 

Nose, Foreign body in 99 

Nursery 9 

Nursing cap 120 

Nursery chair 77 

Nursing mother's diet 26 

Nursing mother's hygiene... 26 
Nursing during mother's ill- 
ness 28 

Nursing habits 28 

Nursing regulations 28 

Oatmeal water 127 

Orange juice 55 

Pacifiers 106 

Pack, Hot mustard 91 

Parasites, Intestinal . . 117 

Pasteurized milk 45 

Patent foods 56 

Pigeon toe 20 

Piles 119 

Pink eye 119 

Pin worms 118 

Pregnancy, Effect of, on 

breast milk 28 

Preparation of food 45 

Prickly heat 115 

Prolapse of rectum 119 

Protruding ears 102 

Puddle bath 90 

Purgatives 34-78-83-94 

Rectal prolapse 119 

Rest for nursing mothers. . . 26 

Restless sleep 17 

Rice water 127 

Rickets 57 

Rubber napkins 75 

Rupture at navel 11 

Scalds 99 

Scales 18 

Scraped steak 130 

Scurvy 116 

Seat worms 118 

Second year feeding 61 

Shirts 11 

Shoes 11 

Short clothes 11 

Sitting alone 20 

Sick room 84 

Skirts 11 

Sleep 16 

Sleeping garments 13 

Sleep, Disturbed 17 



PAGE 

Sore eyes 119 

Soup 129 

Speech 2 2 

Speech delayed 23 

Stammering 23 

Starting artificial food 51 

Starting newborn baby's 

food 52-122 

Sterilizing milk 44 

Stools, Abnormal 54 

Stools, Normal 24 

Sucking thumb 106 

Sugar 49 

Summer clothing 12 

Summer complaint 80 

Supplemental feeding 38 

Swallowing foreign bodies... 94 
Sweets after second year. ... 69 

Sweets for children 65 

Talk, Baby 23 

Talking 22 

Tapeworm 118 

Teeth, Care of 71 

Teething 22-81 

Teeth, Temporary 21 

Temperature of bath 15 

Temperature of food 47 

Temperature of nursery .... 9 

Thermos bottle 74 

Third year feeding 70 

Throat examination 86 

Thrush 116 

Thumb sucking 106 

Toast water 127 

Tongue tie 23 

Tonsils 112 

Training children ...17-28-77-105 

Traveling baby 73 

Underclothing 11 

Urine 24 

Urine, Collecting specimen.. 2£ 

Urine suppression 25 

Vegetables 64-129 

Vegetable soup 129 

Ventilation, Nursery 9 

Vomiting, Acute 93 

Vomiting, Chronic 76 

Walking 20 

Washing mouth 15 

Water 28-64-71-87 

Weaning 39 

Weaning from bottle 62 

Weights 126 

Weighing, Regular 19 

Wetnurse 40 

Worms 117 



MEMORANDUM 



